DrugDispensingTool/PatientsForm.html at main · TamaraChelagat/DrugDispensingTool · GitHub

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<html>
<head>
<title>Home</title>
</head>
<body>
<h2>Patient Information Form</h2>
<form action="add_patients.php" method="post">


    <label for="fname">First name:</label><br>
    <input type="text" id="fname" name="fname"><br>


    <label for="lname">Last name</label><br>
    <input type="text" id="lname" name="lname"><br>

<label for="primary_physician">Primary Physician</label><br>
<input type="text" id"primary_physician" name="primary_physician"><br>

<label for="phoneNumber">Phone Number:</label><br>
    <input type="text" id="phoneNumber" name="phoneNumber"><br>

    <label for="address">Address:</label><br>
    <input type="text" id=" address" name="address"><br>

    <label for="DOB">Date Of Birth:</label><br>
    <input type="date" id="DOB" name="DOB"><br>

    <label for="username">Username:</label><br>
    <input type="text" id="username" name="username"><br>


    <label for="password">Password:</label><br>
    <input type="text" id="password" name="password"><br>

    <input type="submit"name="register" id="register_patients">
</form>
</body>
</html>