Dida_medic
/
patient.html

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	<title>滴答医疗--预约</title>
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	<link rel="stylesheet" href="css/patient.css">
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<script src="js/patient.js"></script>
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<body>
		<a href="javascript:" class="totop">↑</a>
		<div class="header">
			<div class="box980">
					<span class="">
					<svg width=12 height=14 viewBox="70.925 31.625 208.32 294.061" role="img" fill="#178AF0">
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							<path d="M168.085 31.832c4.245-.454 45.943-3.569 84.851 43.417 41.057 49.578 3.873 115.419 3.873 115.419l-88.725 135.018-88.723-135.018s-37.184-65.841 3.873-115.419c38.914-46.986 80.606-43.872 84.851-43.417zm47.415 96.445c0-26.184-21.226-47.409-47.414-47.409-26.184 0-47.414 21.226-47.414 47.409 0 26.189 21.231 47.414 47.414 47.414 26.188 0 47.414-21.225 47.414-47.414z"></path>
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					500 Terry Francois Street San Francisco, CA 94158</span>
					<span class="fr">
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					Tel: 123-456-7890</span>
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		<div class="nav">
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				<img  class="logo" src="img/logo.png" alt="">
				<ul>
					<li><a href="index.html">主页</a></li>
					<li><a href="about.html">关于我们</a></li>
					<li><a href="department.html">就诊 购药 化验</a></li>
					<li><a href="hzinfo/pa_log.html">患者入口</a></li>
					<li><a class="hover" href="doctor.html">专家信息</a></li>
					<li><a href="contact.html">联系我们</a></li>
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		<div class="title_us">
			<div class="box980">
				<h3>预约申请</h3>
			</div>
		</div>
		<div class="content">
			<div class="box980">
					<form action="data/insert.php" id="form1" method="POST">
						<h3>输入相关信息,问诊医生到您家</h3>
						<table>
							<tr>
								<td>
								<p class="title">请输入姓名</p>
							    <input type="text" placeholder="请输入姓名" name="pname" id="username">
								</td>
								<td>
									<span class="tip" id="usernameTips"></span>
								</td>
							</tr>
							<tr>

								<td>
									<p class="title">请输入手机号</p>
									<input placeholder="请输入手机号" type="text" name="pnumber" id="phone" maxlength="11">
								</td>
								<td>
										<span class="tip" id="phoneTips"></span>
								</td>
							</tr>
							<tr>
								<td>
									<p class="title">请选择科室</p>
									<select name="dept" id="office" >
										<option>请选择科室</option>
										<option value="骨科">骨科</option>
										<option value="儿科">儿科</option>
										<option value="妇科">妇科</option>
										<option value="呼吸科">呼吸科</option>
									</select>
								</td>
								<td>
										<span class="tip" id="officeTips"></span>
								</td>
							</tr>

							<tr>
								<td>
										<p class="title">预约时间</p>
										<select name="ptime" id="ptime" >
											<option>预约时间</option>
											<option value="8:00~10:00">8:00~10:00</option>
											<option value="10:00~11:00">10:00~11:00</option>
											<option value="13:30~14:30">13:30~14:30</option>
											<option value="14:30~16:00">14:30~16:00</option>
											<option value="16:00~17:00">16:00~17:00</option>
										</select>
								</td>

									<td>
											<span class="tip" id="ptimeTips"></span>
									</td>
							</tr>

							<tr>

								<td >
									<p class="title">请选择医师</p>
									<input placeholder="请选择医师" type="text" name="dname" id="doctor">
								</td>
								<td>
										<span class="tip" id="doctorTips"></span>
								</td>
							</tr>


						</table>
						<input type="submit" name="submit" value="提交">
					</form>
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					<p>© 2023 by Medical Clinic. Proudly created with Wix.com</p>
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					胜利街500号&nbsp;河北 秦皇岛市 94158
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