Scribd
Upload
5 views2 pages

Sample Code

Uploaded by

madhanrajan567
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as TXT, PDF, TXT or read online on Scribd
5 views2 pages

Sample Code

Uploaded by

madhanrajan567
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as TXT, PDF, TXT or read online on Scribd
You are on page 1/ 2

Here's a simple HTML program for a hospital application form:

<!DOCTYPE html>
<html lang="en">
<head>
<meta charset="UTF-8">
<meta name="viewport" content="width=device-width, initial-scale=1.0">
<title>Hospital Application Form</title>
<style>
body {
font-family: Arial, sans-serif;
margin: 20px;
}
form {
max-width: 400px;
margin: auto;
padding: 20px;
border: 1px solid #ccc;
border-radius: 10px;
background-color: #f9f9f9;
}
label {
display: block;
margin-bottom: 5px;
}
input, select, textarea {
width: 100%;
padding: 10px;
margin-bottom: 15px;
border: 1px solid #ccc;
border-radius: 5px;
}
button {
background-color: #007BFF;
color: white;
border: none;
padding: 10px 20px;
cursor: pointer;
border-radius: 5px;
}
button:hover {
background-color: #0056b3;
}
</style>
</head>
<body>
<h2>Hospital Application Form</h2>
<form action="#" method="post">
<label for="fullName">Full Name:</label>
<input type="text" id="fullName" name="fullName" placeholder="Enter your
full name" required>

<label for="age">Age:</label>
<input type="number" id="age" name="age" placeholder="Enter your age"
required>

<label for="gender">Gender:</label>
<select id="gender" name="gender" required>
<option value="">Select your gender</option>
<option value="male">Male</option>
<option value="female">Female</option>
<option value="other">Other</option>
</select>

<label for="contact">Contact Number:</label>


<input type="tel" id="contact" name="contact" placeholder="Enter your
contact number" required>

<label for="address">Address:</label>
<textarea id="address" name="address" rows="4" placeholder="Enter your
address" required></textarea>

<label for="symptoms">Symptoms/Reason for Visit:</label>


<textarea id="symptoms" name="symptoms" rows="4" placeholder="Describe your
symptoms or reason for visit" required></textarea>

<button type="submit">Submit</button>
</form>
</body>
</html>

Features:

1. Responsive Design: The form adjusts to different screen sizes.

2. Validation: Required fields ensure all necessary information is filled.

3. User-Friendly UI: Includes placeholders and clear labels for po better


usability.

You might also like