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patientdetails.html
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patientdetails.html
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<!DOCTYPE html>
<html>
<head>
<title></title>
<link rel="stylesheet" type="text/css" href="2.css">
</head>
<body>
<form>
<fieldset>
<legend align="center">Registration Form</legend>
<table align="center">
<tr><td>Name</td><td><input type="text" name="name" required="required"/></td></tr>
<tr><td>Profile pic</td><td><input type="file" name="pic" accept="image/*"></td></tr>
<tr><td>Bio</td><td><input type="text" name="bio" required="required"/></td></tr>
<tr><td>Cancer Type</td><td><input type="text" name="cancer" required="required" /></td></tr>
<tr><td>Gender</td><td>Male<input type=radio name="gender" value="m"></td></tr>
<tr><td></td><td>Female<input type=radio name="gender" value="f"></td></tr>
<tr><td>Address</td><td><textarea name="add" rows="10" cols="20"></textarea></td></tr>
<tr><td>Mobile</td><td><input type="integer" name="mobile" required="required" maxlength="10" />
<tr><td>City</td><td><select name="City">
<datalist id="City">
<option value="Mumbai">Mumbai
<option value="Delhi">Delhi
<option value="Chennai">Chennai</select></td></tr>
</datalist>
<tr></tr>
<tr></tr>
<tr><td></td><td><input type=submit id="submit" class="button" value=Submit name=submit></td>
</table>
</fieldset>
</form>
</body>
</html>