Predicare/serarch.html at master · solankipawan/Predicare · GitHub

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<!DOCTYPE html>
<html>
<head>
<meta name="keywords" content="webpage,html elements,some text"/>
<style type=text/css>
</style>
<script type="text/javascript">
</script>
</head>
<style>
body {font-family: Arial, Helvetica, sans-serif;}
* {box-sizing: border-box}

input[type=text], input[type=password] {
  width: 100%;
  padding: 15px;
  margin: 5px 0 22px 0;
  display: inline-block;
  border: none;
  background: #f1f1f1;
}

input[type=text]:focus, input[type=password]:focus {
  background-color: #ddd;
  outline: none;
}
#h{
background-color: #ddd;
  outline: none;
cursor: pointer;
   width: 100%;
   opacity: 0.7;
    padding: 14px 20px;
}
#ju{
background-color: #ddd;
  outline: none;
cursor: pointer;
   width: 100%;
   opacity: 0.7;
    padding: 14px 20px;
}
#ji{
background-color: #ddd;
  outline: none;
cursor: pointer;
   width: 100%;
   opacity: 0.7;
    padding: 14px 20px;
}
hr {
  border: 1px solid #f1f1f1;
  margin-bottom: 25px;

}


button {
  background-color: #4CAF50;
  color: white;
  padding: 14px 20px;
  margin: 8px 0;
  border: none;
  cursor: pointer;
  width: 100%;
  opacity: 0.9;
}

button:hover {
  opacity:1;
}

.cancelbtn {
  padding: 14px 20px;
  background-color: #f44336;
}

/
.cancelbtn, .signupbtn {
  float: left;
  width: 50%;
}


.container {
  padding: 16px;
}


.clearfix::after {
  content: "";
  clear: both;
  display: table;
}


@media screen and (max-width: 300px) {
  .cancelbtn, .signupbtn {
     width: 100%;
  }
}
</style>
<body>

<form action="/action_page.php" style="border:1px solid #ccc">
  <div class="container">
    <h1>Enter Details</h1>
    <p>Fill the form and upload required Documents!</p>
    <hr>
      <label for="name"><b>Select Disease</b></label>
      <br><br>
    <select id="h">
    <option>Malaria</option>
    <option>Dengue</option>
    <option>ChickenGuniya</option>
    <option>Typhoid</option>
    <option>Cholera</option>
    <option>Tuberculosis</option>
    <option>Common Cold</option>
    <option>Other Viral Infections</option>
    </select><br><br>
    <label for="age"><b>Consultant Doctor ID
    <input type="text" placeholder="Enter ID" required>
    <label for="gen"><b>Select Stage


    <input id="rd1" type="radio" name="grp1" value="option1">Initial Stage</input>

<input id="rd2" type="radio" name="grp1" value="option2">Secondary Stage</input>

<input id="rd3" type="radio" name="grp1" value="option3">Last Stage</input>
<br>
<br>
 <label  for="hel"><b>Upload Report from a Certified Laboratory/Doctor:</label>
 <br>
 <br>
<form action="index.php" method="post" encttype="multipart/form-data">
<label for="file">Choose a file:</label>
<input id="ji"type="file" name="file1"/><br><br>
<input type="submit" value="Upload!">
</form>
<br>
<br>


    <label>
      <input type="checkbox" checked="checked" name="remember" style="margin-bottom:15px"> Are the above details correct!
    </label>

    <p>By Submitting the above details,you abide by our <a href="#" style="color:dodgerblue">Terms & Privacy</a>.</p>

    <div class="clearfix">
      <button type="button" class="cancelbtn">Cancel</button>
      <button type="submit" class="signupbtn">Submit</button>
    </div>
  </div>
</form>

</body>
</html>