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patient.html
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<!DOCTYPE html>
<html>
<head>
</head>
<body>
<link rel="stylesheet" type="text/css" href="css/style.css">
<script src="https://ajax.googleapis.com/ajax/libs/jquery/2.1.3/jquery.min.js"></script>
<script src="js/script.js"></script>
<script src="js/register.js"></script>
<ul>
<li>
<a href="#">
<span class="span-logo">
<img src="image/index.png" id="hos1">
</span>
</a>
</li>
<li><a class="active" href="loggedin.php">Home</a></li>
<li><a href="checklog.php">Doctor's Schedule</a></li>
<li class="swag"><a href="login.html">Logout</a></li>
<li class="swag"><a href="myaccount.php">My Account</a></li>
</ul>
<div class="placement">
<h1 style="
padding-left: 35%;"> Patient form</h1>
<form class="modal-content" id="form-shower" action="action.php" method="post">
<div class="container">
<label><b>Name</b></label>
<input type="text" placeholder="Enter Name" name="name" id="fns" required>
<label><b>Address</b></label>
<input type="textarea" placeholder="Enter Address" name="address" required>
<label><b>E-mail</b></label>
<input type="textarea" placeholder="Enter E-mail" name="e-mail" required>
<label><b>Mobile</b></label>
<input type="number" placeholder="Enter Mobile Number" name="mobile" required>
<label class="dept"><b>Department</b></label>
<select name="dept" required id="choose">
<option value="None selected">Please select below</option>
<option value="Pathology">Pathology</option>
<option value="Cardiology">Cardiology</option>
<option value="X-Rays">X-Rays</option>
<option value="Sonography">Sonography</option>
etc.
</select>
<div class="appoint">
<label id="app1"><b>Appointment Date</b></label>
<input type="date" id="dateapp" placeholder="Enter Appointment Date" name="adate" onblur="myFunction()" required>
</div>
<label class="time"><b>Appointment Time</b></label>
<select name="time" required >
<option value="10am-11am">10 am - 11 am</option>
<option value="12pm-1pm">12 pm - 1 pm</option>
<option value="3pm-4pm">3 pm - 4 pm</option>
<option value="5pm-6pm">5 pm - 6 pm</option>
etc.
</select>
<div class="gender">
<input type="checkbox" checked="checked" name="gen" value="M"> Male
<input type="checkbox" name="gen"value="F"> Female
</div>
<div class="clearfix">
<button type="button" onclick="document.getElementById('id01').style.display='none'" class="cancelbtn" ">Cancel</button>
<button type="submit" class="signupbtn">Submit</button>
</div>
</div>
</form>
</div>
</body>
</html>