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form-vertical.html
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<!DOCTYPE html>
<html lang="en">
<head>
<meta charset="utf-8">
<meta name="viewport" content="width=device-width, initial-scale=1.0, user-scalable=0">
<title>Preclinic - Medical & Hospital - Bootstrap 4 Admin Template</title>
<link rel="stylesheet" type="text/css" href="assets/css/bootstrap.min.css">
<link rel="stylesheet" type="text/css" href="assets/css/font-awesome.min.css">
<link rel="stylesheet" type="text/css" href="assets/css/fullcalendar.min.css">
<link rel="stylesheet" type="text/css" href="assets/css/dataTables.bootstrap4.min.css">
<link rel="stylesheet" type="text/css" href="assets/css/select2.min.css">
<link rel="stylesheet" type="text/css" href="assets/css/style.css">
<!--[if lt IE 9]>
<script src="assets/js/html5shiv.min.js"></script>
<script src="assets/js/respond.min.js"></script>
<![endif]-->
</head>
<body>
<div class="main-wrapper">
<div class="header">
<div class="header-left">
<a href="index.html" class="logo">
<img src="assets/img/logo.png" width="35" height="35" alt=""> <span>Preclinic</span>
</a>
</div>
<a id="toggle_btn" href="javascript:void(0);"><i class="fa fa-bars"></i></a>
<a id="mobile_btn" class="mobile_btn float-left" href="#sidebar"><i class="fa fa-bars"></i></a>
<ul class="nav user-menu float-right">
<li class="nav-item dropdown d-none d-sm-block">
<a href="#" class="dropdown-toggle nav-link" data-toggle="dropdown"><i class="fa fa-bell-o"></i> <span class="badge badge-pill bg-danger float-right">3</span></a>
<div class="dropdown-menu notifications">
<div class="topnav-dropdown-header">
<span>Notifications</span>
</div>
<div class="drop-scroll">
<ul class="notification-list">
<li class="notification-message">
<a href="activities.html">
<div class="media">
<span class="avatar">
<img alt="John Doe" src="assets/img/user.jpg" class="img-fluid">
</span>
<div class="media-body">
<p class="noti-details"><span class="noti-title">John Doe</span> added new task <span class="noti-title">Patient appointment booking</span></p>
<p class="noti-time"><span class="notification-time">4 mins ago</span></p>
</div>
</div>
</a>
</li>
<li class="notification-message">
<a href="activities.html">
<div class="media">
<span class="avatar">V</span>
<div class="media-body">
<p class="noti-details"><span class="noti-title">Tarah Shropshire</span> changed the task name <span class="noti-title">Appointment booking with payment gateway</span></p>
<p class="noti-time"><span class="notification-time">6 mins ago</span></p>
</div>
</div>
</a>
</li>
<li class="notification-message">
<a href="activities.html">
<div class="media">
<span class="avatar">L</span>
<div class="media-body">
<p class="noti-details"><span class="noti-title">Misty Tison</span> added <span class="noti-title">Domenic Houston</span> and <span class="noti-title">Claire Mapes</span> to project <span class="noti-title">Doctor available module</span></p>
<p class="noti-time"><span class="notification-time">8 mins ago</span></p>
</div>
</div>
</a>
</li>
<li class="notification-message">
<a href="activities.html">
<div class="media">
<span class="avatar">G</span>
<div class="media-body">
<p class="noti-details"><span class="noti-title">Rolland Webber</span> completed task <span class="noti-title">Patient and Doctor video conferencing</span></p>
<p class="noti-time"><span class="notification-time">12 mins ago</span></p>
</div>
</div>
</a>
</li>
<li class="notification-message">
<a href="activities.html">
<div class="media">
<span class="avatar">V</span>
<div class="media-body">
<p class="noti-details"><span class="noti-title">Bernardo Galaviz</span> added new task <span class="noti-title">Private chat module</span></p>
<p class="noti-time"><span class="notification-time">2 days ago</span></p>
</div>
</div>
</a>
</li>
</ul>
</div>
<div class="topnav-dropdown-footer">
<a href="activities.html">View all Notifications</a>
</div>
</div>
</li>
<li class="nav-item dropdown d-none d-sm-block">
<a href="javascript:void(0);" id="open_msg_box" class="hasnotifications nav-link"><i class="fa fa-comment-o"></i> <span class="badge badge-pill bg-danger float-right">8</span></a>
</li>
<li class="nav-item dropdown has-arrow">
<a href="#" class="dropdown-toggle nav-link user-link" data-toggle="dropdown">
<span class="user-img"><img class="rounded-circle" src="assets/img/user.jpg" width="40" alt="Admin">
<span class="status online"></span></span>
<span>Admin</span>
</a>
<div class="dropdown-menu">
<a class="dropdown-item" href="profile.html">My Profile</a>
<a class="dropdown-item" href="edit-profile.html">Edit Profile</a>
<a class="dropdown-item" href="settings.html">Settings</a>
<a class="dropdown-item" href="login.html">Logout</a>
</div>
</li>
</ul>
<div class="dropdown mobile-user-menu float-right">
<a href="#" class="nav-link dropdown-toggle" data-toggle="dropdown" aria-expanded="false"><i class="fa fa-ellipsis-v"></i></a>
<div class="dropdown-menu dropdown-menu-right">
<a class="dropdown-item" href="profile.html">My Profile</a>
<a class="dropdown-item" href="edit-profile.html">Edit Profile</a>
<a class="dropdown-item" href="settings.html">Settings</a>
<a class="dropdown-item" href="login.html">Logout</a>
</div>
</div>
</div>
<div class="sidebar" id="sidebar">
<div class="sidebar-inner slimscroll">
<div id="sidebar-menu" class="sidebar-menu">
<ul>
<li class="menu-title">Main</li>
<li>
<a href="index.html"><i class="fa fa-dashboard"></i> <span>Dashboard</span></a>
</li>
<li>
<a href="doctors.html"><i class="fa fa-user-md"></i> <span>Doctors</span></a>
</li>
<li>
<a href="patients.html"><i class="fa fa-wheelchair"></i> <span>Patients</span></a>
</li>
<li>
<a href="appointments.html"><i class="fa fa-calendar"></i> <span>Appointments</span></a>
</li>
<li>
<a href="schedule.html"><i class="fa fa-calendar-check-o"></i> <span>Doctor Schedule</span></a>
</li>
<li>
<a href="departments.html"><i class="fa fa-hospital-o"></i> <span>Departments</span></a>
</li>
<li class="submenu">
<a href="#"><i class="fa fa-user"></i> <span> Employees </span> <span class="menu-arrow"></span></a>
<ul style="display: none;">
<li><a href="employees.html">Employees List</a></li>
<li><a href="leaves.html">Leaves</a></li>
<li><a href="holidays.html">Holidays</a></li>
<li><a href="attendance.html">Attendance</a></li>
</ul>
</li>
<li class="submenu">
<a href="#"><i class="fa fa-money"></i> <span> Accounts </span> <span class="menu-arrow"></span></a>
<ul style="display: none;">
<li><a href="invoices.html">Invoices</a></li>
<li><a href="payments.html">Payments</a></li>
<li><a href="expenses.html">Expenses</a></li>
<li><a href="taxes.html">Taxes</a></li>
<li><a href="provident-fund.html">Provident Fund</a></li>
</ul>
</li>
<li class="submenu">
<a href="#"><i class="fa fa-book"></i> <span> Payroll </span> <span class="menu-arrow"></span></a>
<ul style="display: none;">
<li><a href="salary.html"> Employee Salary </a></li>
<li><a href="salary-view.html"> Payslip </a></li>
</ul>
</li>
<li>
<a href="chat.html"><i class="fa fa-comments"></i> <span>Chat</span> <span class="badge badge-pill bg-primary float-right">5</span></a>
</li>
<li class="submenu">
<a href="#"><i class="fa fa-video-camera camera"></i> <span> Calls</span> <span class="menu-arrow"></span></a>
<ul style="display: none;">
<li><a href="voice-call.html">Voice Call</a></li>
<li><a href="video-call.html">Video Call</a></li>
<li><a href="incoming-call.html">Incoming Call</a></li>
</ul>
</li>
<li class="submenu">
<a href="#"><i class="fa fa-envelope"></i> <span> Email</span> <span class="menu-arrow"></span></a>
<ul style="display: none;">
<li><a href="compose.html">Compose Mail</a></li>
<li><a href="inbox.html">Inbox</a></li>
<li><a href="mail-view.html">Mail View</a></li>
</ul>
</li>
<li class="submenu">
<a href="#"><i class="fa fa-commenting-o"></i> <span> Blog</span> <span class="menu-arrow"></span></a>
<ul style="display: none;">
<li><a href="blog.html">Blog</a></li>
<li><a href="blog-details.html">Blog View</a></li>
<li><a href="add-blog.html">Add Blog</a></li>
<li><a href="edit-blog.html">Edit Blog</a></li>
</ul>
</li>
<li>
<a href="assets.html"><i class="fa fa-cube"></i> <span>Assets</span></a>
</li>
<li>
<a href="activities.html"><i class="fa fa-bell-o"></i> <span>Activities</span></a>
</li>
<li class="submenu">
<a href="#"><i class="fa fa-flag-o"></i> <span> Reports </span> <span class="menu-arrow"></span></a>
<ul style="display: none;">
<li><a href="expense-reports.html"> Expense Report </a></li>
<li><a href="invoice-reports.html"> Invoice Report </a></li>
</ul>
</li>
<li>
<a href="settings.html"><i class="fa fa-cog"></i> <span>Settings</span></a>
</li>
<li class="menu-title">UI Elements</li>
<li class="submenu">
<a href="#"><i class="fa fa-laptop"></i> <span> Components</span> <span class="menu-arrow"></span></a>
<ul style="display: none;">
<li><a href="uikit.html">UI Kit</a></li>
<li><a href="typography.html">Typography</a></li>
<li><a href="tabs.html">Tabs</a></li>
</ul>
</li>
<li class="submenu">
<a href="#"><i class="fa fa-edit"></i> <span> Forms</span> <span class="menu-arrow"></span></a>
<ul style="display: none;">
<li><a href="form-basic-inputs.html">Basic Inputs</a></li>
<li><a href="form-input-groups.html">Input Groups</a></li>
<li><a href="form-horizontal.html">Horizontal Form</a></li>
<li><a class="active" href="form-vertical.html">Vertical Form</a></li>
</ul>
</li>
<li class="submenu">
<a href="#"><i class="fa fa-table"></i> <span> Tables</span> <span class="menu-arrow"></span></a>
<ul style="display: none;">
<li><a href="tables-basic.html">Basic Tables</a></li>
<li><a href="tables-datatables.html">Data Table</a></li>
</ul>
</li>
<li>
<a href="calendar.html"><i class="fa fa-calendar"></i> <span>Calendar</span></a>
</li>
<li class="menu-title">Extras</li>
<li class="submenu">
<a href="#"><i class="fa fa-columns"></i> <span>Pages</span> <span class="menu-arrow"></span></a>
<ul style="display: none;">
<li><a href="login.html"> Login </a></li>
<li><a href="register.html"> Register </a></li>
<li><a href="forgot-password.html"> Forgot Password </a></li>
<li><a href="change-password2.html"> Change Password </a></li>
<li><a href="lock-screen.html"> Lock Screen </a></li>
<li><a href="profile.html"> Profile </a></li>
<li><a href="gallery.html"> Gallery </a></li>
<li><a href="error-404.html">404 Error </a></li>
<li><a href="error-500.html">500 Error </a></li>
<li><a href="blank-page.html"> Blank Page </a></li>
</ul>
</li>
<li class="submenu">
<a href="javascript:void(0);"><i class="fa fa-share-alt"></i> <span>Multi Level</span> <span class="menu-arrow"></span></a>
<ul style="display: none;">
<li class="submenu">
<a href="javascript:void(0);"><span>Level 1</span> <span class="menu-arrow"></span></a>
<ul style="display: none;">
<li><a href="javascript:void(0);"><span>Level 2</span></a></li>
<li class="submenu">
<a href="javascript:void(0);"> <span> Level 2</span> <span class="menu-arrow"></span></a>
<ul style="display: none;">
<li><a href="javascript:void(0);">Level 3</a></li>
<li><a href="javascript:void(0);">Level 3</a></li>
</ul>
</li>
<li><a href="javascript:void(0);"><span>Level 2</span></a></li>
</ul>
</li>
<li>
<a href="javascript:void(0);"><span>Level 1</span></a>
</li>
</ul>
</li>
</ul>
</div>
</div>
</div>
<div class="page-wrapper">
<div class="content">
<div class="row">
<div class="col-sm-12">
<h4 class="page-title">Vertical Form</h4>
</div>
</div>
<div class="row">
<div class="col-md-6">
<div class="card-box">
<h4 class="card-title">Basic Form</h4>
<form action="#">
<div class="form-group">
<label>First Name</label>
<input type="text" class="form-control">
</div>
<div class="form-group">
<label>Last Name</label>
<input type="text" class="form-control">
</div>
<div class="form-group">
<label>Email Address</label>
<input type="email" class="form-control">
</div>
<div class="form-group">
<label>Username</label>
<input type="text" class="form-control">
</div>
<div class="form-group">
<label>Password</label>
<input type="password" class="form-control">
</div>
<div class="form-group">
<label>Repeat Password</label>
<input type="password" class="form-control">
</div>
<div class="text-right">
<button type="submit" class="btn btn-primary">Submit</button>
</div>
</form>
</div>
</div>
<div class="col-md-6">
<div class="card-box">
<h4 class="card-title">Address Form</h4>
<form action="#">
<div class="form-group">
<label>Address Line 1</label>
<input type="text" class="form-control">
</div>
<div class="form-group">
<label>Address Line 2</label>
<input type="text" class="form-control">
</div>
<div class="form-group">
<label>City</label>
<input type="text" class="form-control">
</div>
<div class="form-group">
<label>State</label>
<input type="text" class="form-control">
</div>
<div class="form-group">
<label>Country</label>
<input type="text" class="form-control">
</div>
<div class="form-group">
<label>Postal Code</label>
<input type="text" class="form-control">
</div>
<div class="text-right">
<button type="submit" class="btn btn-primary">Submit</button>
</div>
</form>
</div>
</div>
</div>
<div class="row">
<div class="col-md-12">
<div class="card-box">
<h4 class="card-title">Two Column Vertical Form</h4>
<form action="#">
<h4 class="card-title">Personal Information</h4>
<div class="row">
<div class="col-md-6">
<div class="form-group">
<label>First Name</label>
<input type="text" class="form-control">
</div>
<div class="form-group">
<label>Last Name</label>
<input type="text" class="form-control">
</div>
<div class="form-group">
<label>Blood Group</label>
<select class="select">
<option>Select</option>
<option value="1">A+</option>
<option value="2">O+</option>
<option value="3">B+</option>
<option value="4">AB+</option>
</select>
</div>
<div class="form-group">
<label class="display-block">Gender:</label>
<div class="form-check form-check-inline">
<input class="form-check-input" type="radio" name="gender" id="gender_male" value="option1">
<label class="form-check-label" for="gender_male">Male</label>
</div>
<div class="form-check form-check-inline">
<input class="form-check-input" type="radio" name="gender" id="gender_female" value="option2">
<label class="form-check-label" for="gender_female">Female</label>
</div>
</div>
</div>
<div class="col-md-6">
<div class="form-group">
<label>Username</label>
<input type="text" class="form-control">
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