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requests.php
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requests.php
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<?php
include('layout.php');
?>
<html>
<head>
</head>
<body>
<br>
<div class="registerbox">
<form action="requestsdb.php" method="POST">
<h1>REQUESTS</h1>
<link rel="stylesheet" type="text/css" href="pagestyle.css">
<select class="drpdtwn" id="alphalist">
<option value="patient name">patient name</option>
<option value="patient number">patient number</option>
</select>
<input class="insearch" type="text" placeholder="Search..."/>
<span class="fa fa-search"></span>
<br>
<label>Patient number:</label><br>
<input type="text" name="ptnumber" required="number"><br>
<label>Patient name:</label><br>
<input type="text" name="name" required="name"><br>
<label>Requested by:</label><br>
<input type="text" name="requestor" required="name"><br>
<label>Assigned to:</label><br>
<input type="text" name="counsellor" required="name"><br>
<label>Counselling Date:</label><br>
<input type="date" name="tdate"><br>
<label>Details:</label><br>
<textarea style="height: inherit" class="form-control "
name="details" id="Details" rows="5" cols="68"> </textarea><br>
<br>
<input style="width:25%" type="submit" name="submit-" value="save">
</br>
</div>
</form>
</body>
</html>