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Ambulance.html
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Ambulance.html
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<!doctype html>
<html lang="en">
<head>
<!-- Required meta tags -->
<meta charset="utf-8">
<meta name="viewport" content="width=device-width, initial-scale=1">
<!-- Bootstrap CSS -->
<link rel="stylesheet" href="https://stackpath.bootstrapcdn.com/bootstrap/5.0.0-alpha2/css/bootstrap.min.css" integrity="sha384-DhY6onE6f3zzKbjUPRc2hOzGAdEf4/Dz+WJwBvEYL/lkkIsI3ihufq9hk9K4lVoK" crossorigin="anonymous">
<link rel = "icon" href = "images/icon.png" type = "image/x-icon">
<title>Medi Assist</title>
<style>
body{
overflow-x: hidden;
}
</style>
</head>
<body>
<nav class="navbar navbar-light bg-light">
<div class="container-fluid border-dark border-bottom">
<a class="navbar-brand" href="#">
<img src="images/icon.png" alt="" width="50" height="50" class="d-inline-block align-top">
<span class="h1">MediAssist</span>
</a>
<ul class="nav justify-content-end">
<li class="nav-item">
<a class="nav-link" href="medicines.php"><b>Buy Medicines</b></a>
</li>
<li class="nav-item">
<a class="nav-link" href="doctors.php"><b>Doctors' Information</b></a>
</li>
<li class="nav-item">
<a class="nav-link" href="ambulance.php"><b>Ambulance Service</b></a>
</li>
<div class="btn-group dropleft">
<button type="button" class="btn btn-light dropdown-toggle" data-toggle="dropdown" aria-expanded="false">
<img class="mr-2" src="Images/profile.svg" width="30" height="30" alt="" loading="lazy">
</button>
<ul class="dropdown-menu mt-5">
<li><a class="dropdown-item large" href="#">Hey, Sarthak Keshari</a></li>
<li><hr class="dropdown-divider"></li>
<li><a class="dropdown-item medium mb-2" href="chessboard_rank.html"><img src="rank.svg" width="20" height="20" alt="" loading="lazy">Self Assessment</a></li>
<li><a class="dropdown-item medium mb-2" href="chessboard.html"><img src="cash_out.svg" width="20" height="20" alt="" loading="lazy">Health Record</a></li>
<li><a class="dropdown-item medium mb-2" href="chessboard.html"><img src="logout.svg" width="20" height="20" alt="" loading="lazy">Log Out</a></li>
<hr>
<li><a class="dropdown-item medium mb-2" href="chessboard_rank.html"><img src="rank.svg" width="20" height="20" alt="" loading="lazy">About Us</a></li>
<li><a class="dropdown-item medium mb-2" href="chessboard_rank.html"><img src="rank.svg" width="20" height="20" alt="" loading="lazy">Contact Us</a></li>
</ul>
</div>
<!-- <li class="nav-item">
<a class="nav-link disabled" href="#" tabindex="-1" aria-disabled="true">Disabled</a>
</li> -->
</ul>
</div>
</nav>
<div class="container-fluid">
<div class="row justify-content-center">
<p class="h3 m-0 text-center">Emergency Ambulance Services</p>
<p class="m-0 text-center">(A free service - Each life matters)</p>
</div>
<div class="row d-flex justify-content-center bg-success p-2 mt-4 mb-4">
<div class="col-10 h2 text-center text-white">
Call Us At - 9087654321 <img src="Images/emergency_call.gif" width="100" alt="">
</div>
</div>
<div class="row mb-5 ml-2">
<div class="col-10 text-danger">
<small class="font-weight-bold">
If you couldn't connect to us via call then please fill the below form. We'll reach out to you within next 15 minutes.
</small>
</div>
</div>
<div class="row justify-content-center pb-4">
<div class="col-5 p-0 justify-content-end">
<hr>
</div>
<span class="col-1 p-0 text-center">
<p class="h3">OR</p>
</span>
<div class="col-5 p-0 justify-content-start">
<hr>
</div>
</div>
<div class="row bg-light">
<div class="col-8">
<div class="row p-4 mt-5">
<div class="row h4 border-bottom border-dark d-inline-block">Patient's Information<span class="p-1" style="color: red;">*</span></div>
<div class="row">
<div class="col-6">
<div class="input-group mb-3">
<span class="input-group-text" id="inputGroup-sizing-default">First Name<span style="color: red;">*</span></span>
<input type="text" class="form-control col-6" aria-label="Sizing example input" aria-describedby="inputGroup-sizing-default">
</div>
</div>
<div class="col-6">
<div class="input-group mb-3">
<span class="input-group-text" id="inputGroup-sizing-default">Last Name<span style="color: red;">*</span></span>
<input type="text" class="form-control col-6" aria-label="Sizing example input" aria-describedby="inputGroup-sizing-default">
</div>
</div>
</div>
<div class="row">
<div class="col-4">
<div class="input-group mb-3">
<span class="input-group-text" id="inputGroup-sizing-default">D.O.B<span style="color: red;">*</span></span>
<input type="date" class="form-control col-6" aria-label="Sizing example input" aria-describedby="inputGroup-sizing-default">
</div>
</div>
<div class="col-2">
<div class="input-group mb-3">
<span class="input-group-text" id="inputGroup-sizing-default">Age<span style="color: red;">*</span></span>
<input type="number" class="form-control col-6" aria-label="Sizing example input" aria-describedby="inputGroup-sizing-default" min="0" max="110" required>
</div>
</div>
<div class="col-3 d-flex">
<div class="input-group mb-3">
<span class="input-group-text" id="inputGroup-sizing-default">Gender<span style="color: red;">*</span></span>
<input type="radio" class="btn-check" name="options-outlined" id="male-outlined" autocomplete="off" required>
<label class="btn btn-outline-success ml-1 p-1" for="male-outlined">Male</label>
<input type="radio" class="btn-check" name="options-outlined" id="female-outlined" autocomplete="off" required>
<label class="btn btn-outline-success ml-1 p-1" for="female-outlined">Female</label>
</div>
</div>
<div class="col-3 d-flex">
<div class="input-group mb-3">
<span class="input-group-text" id="inputGroup-sizing-default">Blood Group<span style="color: red;">*</span></span>
<select class="form-select" aria-label="Default select example">
<option value="O+" selected>O+</option>
<option value="A+">A+</option>
<option value="B+">B+</option>
<option value="AB+">AB+</option>
<option value="A-">A-</option>
<option value="B-">B-</option>
<option value="O-">O-</option>
<option value="AB-">AB-</option>
</select>
</div>
</div>
</div>
<div class="row">
<div class="col-12">
<div class="input-group mb-3">
<span class="input-group-text" id="inputGroup-sizing-default">Aadhar Card Number<span style="color: red;">*</span></span>
<input type="text" class="form-control col-6" aria-label="Sizing example input" aria-describedby="inputGroup-sizing-default" required>
</div>
</div>
</div>
<div class="row">
<div class="mb-3">
<span class="input-group-text" id="inputGroup-sizing-default">Address<span style="color: red;">*</span></span>
<textarea class="form-control" id="exampleFormControlTextarea1" rows="3" required></textarea>
</div>
</div>
<div class="row">
<div class="mb-3">
<label for="exampleFormControlTextarea1" class="form-label">Any Additional Information</label>
<textarea class="form-control" id="exampleFormControlTextarea1" rows="3"></textarea>
</div>
</div>
</div>
<div class="row p-5 pt-2 mb-5">
<!-- <button type="submit" class="btn btn-success btn-lg">Submit Medical Details</button> -->
<a href="menu.html" class="btn btn-success btn-lg" type="submit" role button>Call For Ambulance</a>
</div>
</div>
<div class="col-4 border-left border-dark align-items-center">
<div class="row mt-5 pt-5">
<div>
<img class=" p-2" src="Images/ambulance.png" width="500" alt="">
</div>
</div>
</div>
</div>
</div>
<!-- Optional JavaScript; choose one of the two! -->
<!-- Option 1: Bootstrap Bundle with Popper.js -->
<script src="https://stackpath.bootstrapcdn.com/bootstrap/5.0.0-alpha2/js/bootstrap.bundle.min.js" integrity="sha384-BOsAfwzjNJHrJ8cZidOg56tcQWfp6y72vEJ8xQ9w6Quywb24iOsW913URv1IS4GD" crossorigin="anonymous"></script>
<!-- Option 2: Separate Popper.js and Bootstrap JS
<script src="https://cdn.jsdelivr.net/npm/popper.js@1.16.1/dist/umd/popper.min.js" integrity="sha384-9/reFTGAW83EW2RDu2S0VKaIzap3H66lZH81PoYlFhbGU+6BZp6G7niu735Sk7lN" crossorigin="anonymous"></script>
<script src="https://stackpath.bootstrapcdn.com/bootstrap/5.0.0-alpha2/js/bootstrap.min.js" integrity="sha384-5h4UG+6GOuV9qXh6HqOLwZMY4mnLPraeTrjT5v07o347pj6IkfuoASuGBhfDsp3d" crossorigin="anonymous"></script>
-->
</body>
</html>