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Adrian POURCHOT 2022-12-01 12:45:19 +01:00
parent a115b16d14
commit 90b0334e67
2 changed files with 17 additions and 13 deletions
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16
FRONTEND/formulaire.html
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@ -39,16 +39,17 @@
</table>
</nav>
<br>
<section class="container mx-auto">
<form action="https://prendre-mon-rdv.com" method="get" enctype="text/plain" class="formule">
<fieldset class="coordonnées">
<table class="coordonnées2">
<tr>
<td><label for="nom">Nom:</label></td>
<td class="casedroite"><input id="nom" type="text" name="nom" placeholder="votre nom" class="input1" required/></td>
<td class="form-control"><input id="nom" type="text" name="nom" placeholder="votre nom" class="input1" required/></td>
</tr>
<tr>
<td><label for="nom">Prénom:</label></td>
<td class="casedroite"><input id="nom" type="text" name="prénom" placeholder="votre prénom" class="input1" required/></td>
<td class="form-control"><input id="nom" type="text" name="prénom" placeholder="votre prénom" class="input1" required/></td>
</tr>
<tr>
<td><label for="nom">Date de naissance:</label></td>
@ -56,21 +57,21 @@
</tr>
<tr>
<td><label for="nom">Mail:</label></td>
<td class="casedroite"><input id="mail" type="email" name="mail" placeholder="votre mail" class="input4" required/></td>
<td class="form-control"><input id="mail" type="email" name="mail" placeholder="votre mail" class="input4" required/></td>
</tr>
<tr>
<td><label for="nom">Votre site:</label></td>
<td class="casedroite"><input id="site" type="url" name="site" value="http://www." class="input2"/></td>
<td class="form-control"><input id="site" type="url" name="site" value="http://www." class="input2"/></td>
</tr>
<tr>
<td><label for="nom">Genre:</label>
<td class="casedroite"><input type="radio" name="xx" value="xy"/>Homme
<td class="form-control"><input type="radio" name="xx" value="xy"/>Homme
<input type="radio" name="xx" value="xx"/>Femme
</tr>
<tr>
<td>
<label for="nom">Pays:</label>
<td class="casedroite">
<td class="form-control">
Votre pays:
<select name="select">
<optgroup label="Europe">
@ -97,7 +98,7 @@
<input name="xx[]" type="checkbox" value="v1" />Covid - Schéma complet<br>
<input name="xx[]" type="checkbox" value="v2" />Autres vaccins<br>
<br>
<textarea maxlength="500" rows="5" cols="52">
<textarea class="form-control" maxlength="500" rows="5" cols="52">
Vos antécédents médicaux
</textarea>
</fieldset>
@ -107,6 +108,7 @@
<input type="reset" value="Effacer"/>
</fieldset>
</form>
</section>
<br>
<br>
<footer>

14
FRONTEND/priserdv.html
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@ -39,17 +39,18 @@
</table>
</nav>
<br>
<section class="container mx-auto">
<h2>Prendre un rendez-vous</h2>
<form action="exemple1.html" method="get" enctype="text/plain" class="formule">
<fieldset class="coordonnées">
<table class="coordonnées2">
<tr>
<td><label for="nom">Nom:</label></td>
<td class="casedroite"><input id="nom" type="text" name="nom" placeholder="votre nom" class="input1" required/></td>
<td class="form-control"><input id="nom" type="text" name="nom" placeholder="votre nom" class="input1" required/></td>
</tr>
<tr>
<td><label for="nom">Prénom:</label></td>
<td class="casedroite"><input id="nom" type="text" name="prénom" placeholder="votre prénom" class="input1" required/></td>
<td class="form-control"><input id="nom" type="text" name="prénom" placeholder="votre prénom" class="input1" required/></td>
</tr>
<tr>
<td><label for="nom">Date de naissance:</label></td>
@ -57,24 +58,25 @@
</tr>
<tr>
<td><label for="nom">Téléphone:</label></td>
<td class="casedroite"><input id="mail" type="tel" name="téléphone" placeholder="votre téléphone" class="input4" required/></td>
<td class="form-control"><input id="mail" type="tel" name="téléphone" placeholder="votre téléphone" class="input4" required/></td>
</tr>
<tr>
<td><label for="nom">Mail:</label></td>
<td class="casedroite"><input id="site" type="mail" name="mail" placeholder="votre mail" class="input4" required/></td>
<td class="form-control"><input id="site" type="mail" name="mail" placeholder="votre mail" class="input4" required/></td>
</tr>
<tr>
<td><label for="nom">Genre:</label></td>
<td class="casedroite"><input type="radio" name="xx" value="xy"/>Homme
<td class="form-control"><input type="radio" name="xx" value="xy"/>Homme
<input type="radio" name="xx" value="xx"/>Femme</td>
</tr>
<tr>
<td><label for="nom">Service:</label></td>
<td class="casedroite"><input id="service" type="text" name="service" placeholder="Spécialité" class="input4" required/></td>
<td class="form-control"><input id="service" type="text" name="service" placeholder="Spécialité" class="input4" required/></td>
</tr>
</table>
</fieldset>
</form>
</section>
<footer>
En cas d'abscence, vous pouvez <a href="https://www.doctolib.fr">consulter ce site</a><br>
Je suis par ailleurs membre de démonstration des MMT.