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doctordata.html
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doctordata.html
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<!DOCTYPE html>
<html lang="en" >
<head>
<meta charset="UTF-8">
<link rel="stylesheet" href="https://cdnjs.cloudflare.com/ajax/libs/normalize/5.0.0/normalize.min.css">
<link rel="stylesheet" href="./style.css">
</head>
<body>
<!-- Patient Registeration -->
<div class="container">
<div class="title">Doctor Registration</div>
<div class="content">
<form action="insert_doctor.PHP" method="POST">
<div class="user-details">
<div class="input-box">
<span class="details">Doctor Id</span>
<input type="text" placeholder="Enter Docotr Id" required name="doctor_id">
</div>
<div class="input-box">
<span class="details">Supervisor Id</span>
<input type="text" placeholder="Enter supervisor Id" required name="supervisor_id">
</div>
<div class="input-box">
<span class="details">First Name</span>
<input type="text" placeholder="Enter your first name" required name="firstname">
</div>
<div class="input-box">
<span class="details">Last Name</span>
<input type="text" placeholder="Enter your last name" required name="lastname">
</div>
<div class="input-box">
<span class="details">Email</span>
<input type="text" placeholder="Enter your email" required name="email">
</div>
<div class="input-box">
<span class="details">Phone </span>
<input type="text" placeholder="Enter your number" required name="phone">
</div>
<div class="input-box">
<span class="details">StreetAddress</span>
<input type="text" placeholder="Enter your Address" required name="address">
</div>
<div class="input-box">
<span class="details">City</span>
<input type="text" placeholder="Enter your City" required name="city">
</div>
<div class="input-box">
<span class="details">State</span>
<input type="text" placeholder="Enter your state" required name="state">
</div>
<div class="input-box">
<span class="details">Insurance Network</span>
<input type="text" placeholder="Enter Insurance Network" required name="insurance_network">
</div>
</div>
<div class="button">
<input type="submit" value="Register">
</div>
</form>
</div>
</body>
</html>