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  • Experiment No:3 Aim: Form Validation HTML Code

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    Anonymous ukKI8n4ze
    5 views3 pages
    The document describes an HTML form for requesting an appointment. The form collects patient information like name, phone, email, preferred day and time for the appointment, as well as demographic info like age, gender, and whether they are a new or current patient. Users can also provide details on what they need help with in a text area. The form is submitted to an appointment scheduling PHP script.

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    The document describes an HTML form for requesting an appointment. The form collects patient information like name, phone, email, preferred day and time for the appointment, as well as demographic info like age, gender, and whether they are a new or current patient. Users can also provide details on what they need help with in a text area. The form is submitted to an appointment scheduling PHP script.

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    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    5 views3 pages

    Experiment No:3 Aim: Form Validation HTML Code

    Uploaded by

    Anonymous ukKI8n4ze
    The document describes an HTML form for requesting an appointment. The form collects patient information like name, phone, email, preferred day and time for the appointment, as well as demographic info like age, gender, and whether they are a new or current patient. Users can also provide details on what they need help with in a text area. The form is submitted to an appointment scheduling PHP script.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 3

    Experiment No:3

    Aim: Form Validation


    HTML Code:
    <!DOCTYPE html>
    <html ><head>
    <title>Appointment Request</title>
    <link href="appointment.css" rel="stylesheet" type="text/css" />
    </head>
    <body >
    <div >
    <form method="post" action="appointment2.php">
    <div id="header">
    <h2>Appointment Request</h2><br>
    </header>
    <div id="content">
    Thank you for scheduling an appointment with us! Please choose a date or time that is
    convenient for you and we will do our best to accommodate your request. We will contact you by
    phone or send you a confirmation email of your final appointment date and time.</div><br>
    </div>
    <div id="more">
    <ul>
    <li>
    <label>NAME</label>
    <input type="text" name="name" required>
    </li><br>
    <li>
    <label>PHONE </label>
    <input type="tel" name="phone" required>
    </li><br>
    <li>
    <label>EMAIL_ID</label>
    <input type="email" name="email" required>
    </li><br>
    </li><br>
    <li>
    <label class="desc" for="pday"> PREFERRED DAY </label>
    <select name="pday">
    <option value="Select Below" selected="selected" name="pday"> Select Below
    </option>
    <option value="Monday" name="pday"> Monday </option>
    <option value="Tuesday" name="pday"> Tuesday </option>
    <option value="Wednesday" name="pday"> Wednesday </option>
    <option value="Thursday" name="pday"> Thursday </option>

    <option value="Friday" name="pday"> Friday </option>


    </select>
    </li><br>
    <li>
    <label class="desc" for="ptime"> PREFERRED TIME </label>
    <select name="ptime">
    <option value="Select Below" selected="selected" name="time"> Select Below
    </option>
    <option value="7 - 10 a.m." name="ptime"> 7 - 10 a.m. </option>
    <option value="10 - noon" name="ptime"> 10 - noon </option>
    <option value="Noon - 2 p.m." name="ptime"> Noon - 2 p.m. </option>
    <option value="2 - 4 p.m." name="ptime"> 2 - 4 p.m. </option>
    <option value="After 4 p.m." name="ptime"> After 4 p.m. </option>
    </select>
    </li><br>
    <li>
    <label>AGE </label>
    <div> <span>
    <input type="radio" name="age" value="adult" > adult<br>
    </span> <span>
    <input type="radio" name="age" value="child">child<br>
    </span> </div>
    </li><br>
    <label>GENDER </label>
    <div> <span>
    <input type="radio" name="gender" value="female">female<br>
    </span> <span>
    <input type="radio" name="gender" value="male">male<br>
    </span> </div>
    </li><br>
    <li>
    <label>I AM A </label>
    <div><span>
    <input type="radio" name="g" value="New Patient" >New Patient this field is
    required<br>
    </span><span>
    <input type="radio" name="g" value="Current Patient">Current Patient<br>
    </span></div>
    </li><br>
    <li>
    <label class="desc"> HOW CAN WE HELP IT TODAY </label>
    <div>
    <textarea rows="4" cols="50" name="comment"></textarea>
    </div>

    </li><br>

    <li>

    <div>

    <p align="center"><a href="submit.html"><input type="button"


    value="submit"></a></p>
    </div>
    </li><br>
    </ul>
    </form>
    </div>
    </div>
    </body></html>
    Form Validation Page:

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