<head>
<title>User Registration</title>
<meta charset="utf-8" />
<meta name="viewport" content="width=device-width, initial-scale=1.0, user-scalable=0, minimum-scale=1.0, maximum-scale=1.0">
<meta name="apple-mobile-web-app-capable" content="yes">
<meta name="apple-mobile-web-app-status-bar-style" content="black">
<meta content="" name="description" />
<meta content="" name="author" />
<link href="http://fonts.googleapis.com/css?family=Lato:300,400,400italic,600,700|Raleway:300,400,500,600,700|Crete+Round:400italic" rel="stylesheet" type="text/css" />
<link rel="stylesheet" href="vendor/bootstrap/css/bootstrap.min.css">
<link rel="stylesheet" href="vendor/fontawesome/css/font-awesome.min.css">
<link rel="stylesheet" href="vendor/themify-icons/themify-icons.min.css">
<link href="vendor/animate.css/animate.min.css" rel="stylesheet" media="screen">
<link href="vendor/perfect-scrollbar/perfect-scrollbar.min.css" rel="stylesheet" media="screen">
<link href="vendor/switchery/switchery.min.css" rel="stylesheet" media="screen">
<link rel="stylesheet" href="assets/css/styles.css">
<link rel="stylesheet" href="assets/css/plugins.css">
<link rel="stylesheet" href="assets/css/themes/theme-1.css" id="skin_color" />
</head>
<body class="login">
<!-- start: REGISTRATION -->
<div class="row">
<div class="main-login col-xs-10 col-xs-offset-1 col-sm-8 col-sm-offset-2 col-md-4 col-md-offset-4">
<div class="logo margin-top-30">
<h2>Patient Registration</h2>
</div>
<!-- start: REGISTER BOX -->
<div class="box-register">
<form name="registration" id="registration" method="post">
<fieldset>
<legend>
Sign Up
</legend>
<p>
Enter your personal details below:
</p>
<div class="form-group">
<input type="text" class="form-control" name="full_name" placeholder="Full Name" required>
</div>
<div class="form-group">
<input type="text" class="form-control" name="address" placeholder="Address" required>
</div>
<div class="form-group">
<input type="text" class="form-control" name="city" placeholder="City" required>
</div>
<div class="form-group">
<label class="block">
Gender
</label>
<div class="clip-radio radio-primary">
<input type="radio" id="rg-female" name="gender" value="female" >
<label for="rg-female">
Female
</label>
<input type="radio" id="rg-male" name="gender" value="male">
<label for="rg-male">
Male
</label>
</div>
</div>
<p>
Enter your account details below:
</p>
<div class="form-group">
<span class="input-icon">
<input type="email" class="form-control" name="email" id="email" onBlur="userAvailability()" placeholder="Email" required>
<i class="fa fa-envelope"></i> </span>
<span id="user-availability-status1" style="font-size:12px;"></span>
</div>
<div class="form-group">
<span class="input-icon">
<input type="password" class="form-control" id="password" name="password" placeholder="Password" required>
<i class="fa fa-lock"></i> </span>
</div>
<div class="form-group">
<span class="input-icon">
<input type="password" class="form-control" name="password_again" placeholder="Password Again" required>
<i class="fa fa-lock"></i> </span>
</div>
<div class="form-group">
<div class="checkbox clip-check check-primary">
<input type="checkbox" id="agree" value="agree">
<label for="agree">
I agree
</label>
</div>
</div>
<div class="form-actions">
<p>
Already have an account?
<a href="user-login.php">
Log-in
</a>
</p>
<button type="submit" class="btn btn-primary pull-right" id="submit" name="submit">
Submit <i class="fa fa-arrow-circle-right"></i>
</button>
</div>
</fieldset>
</form>
<div class="copyright">
© <span class="current-year"></span><span class="text-bold text-uppercase"> HMS</span>. <span>All rights reserved</span>
</div>
</div>
</div>
</div>
<script src="vendor/jquery/jquery.min.js"></script>
<script src="vendor/bootstrap/js/bootstrap.min.js"></script>
<script src="vendor/modernizr/modernizr.js"></script>
<script src="vendor/jquery-cookie/jquery.cookie.js"></script>
<script src="vendor/perfect-scrollbar/perfect-scrollbar.min.js"></script>
<script src="vendor/switchery/switchery.min.js"></script>
<script src="vendor/jquery-validation/jquery.validate.min.js"></script>
<script src="assets/js/main.js"></script>
<script src="assets/js/login.js"></script>
<script>
jQuery(document).ready(function() {
Main.init();
Login.init();
});
</script>
<script>
function userAvailability() {
$("#loaderIcon").show();
jQuery.ajax({
url: “check_availability.php”,
data:‘email=’+$("#email").val(),
type: “POST”,
success:function(data){
$("#user-availability-status1").html(data);
$("#loaderIcon").hide();
},
error:function (){}
});
}
</body>
<!-- end: BODY -->