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final.html
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<!DOCTYPE html>
<html>
<head>
<title>Velammal Medical College Hospital & Research Institue</title>
<link rel="stylesheet" type="text/css" href="final.css">
</head>
<body>
<h1>Velammal Medical College Hospital & Research Institute</h1>
<h2>Register Here</h2>
<div class="main">
<div class="register">
<form id="register" method="post">
<div id="left">
<label>UHID :</label>
<input type="text" name="uhid" id="uhid" class="uhid" style="border-radius: 10px;">
</div>
<div id="right">
<label>Date: </label>
<input type="Date" name="dob" id="date" style="border-radius: 10px;">
    
<label>Time: </label>
<input type="time" name="dob" id="time" style="border-radius: 10px;">
</div>
<br><br><br><br><br>
<div id="left">
<label>Name </label>
               : <input type="text" name="fname" id="name" placeholder="Enter your name" style="border-radius: 10px;">
</div>
<div id="right">
<label>Father/ Mother/Husband Name : </label>
<input type="text" name="fname" id="name" placeholder="Enter your gaurdian name" style="border-radius: 10px;">
</div>
<br><br><br>
<div id="left">
<label>Date of birth </label>
   : <input type="Date" name="dob" id="dateofbirth" style="border-radius: 10px;">
</div>
<div id="right">
       <label>Religion : </label>
<input type="text" name="religion" id="religion" placeholder="Enter your religion" style="border-radius: 10px;">
</div>
<div id="right">
 <label>Age : </label>
 <input type="number" name="age" id="age" placeholder="Enter your age" style="border-radius: 10px;">
</div> <br><br><br>
<div id="left">
<label>Martial Status : </label>
<input type="radio" name="status" id="single" class="one"><span id="sin" > Single </span>
<input type="radio" name="status" id="Married" class="one"><span id="married">Married</span>
</div>
<div id="right1">
<label>Sex </label>
:<input type="radio" name="Gender" id="male" class="two">
<span id="male">Male</span>
<input type="radio" name="Gender" id="female" class="two">
<span id="female">female</span>
</div><br><br><br>
<label>Contact Details</label><br><br>
<label>Address : </label><br><br>
<textarea name="address" class="three" style="border-radius: 10px;"></textarea>
<br><br><br>
<div id="left">
<label>City </label>
                : <input type="text" name="city" id="city" placeholder="Enter your city" style="border-radius: 10px;">
</div>
<div id="right">
<label>State : </label>
<input list="state" name="text" placeholder="select your state" style="border-radius: 10px;" />
<datalist id="state">
<option>Andhra Pradesh</option>
<option>Assam</option>
<option>Arunachal Pradesh</option>
<option>Bihar</option>
<option>Goa</option>
<option>Gujarat</option>
<option>Jammu and Kashmir</option>
<option>Jharkhand</option>
<option>West Bengal</option>
<option>Karnataka</option>
<option>Kerala</option>
<option>Madhya Pradesh</option>
<option>Maharashtra</option>
<option>Manipur</option>
<option>Meghalaya</option>
<option>Mizoram</option>
<option>Nagaland</option>
<option>Orissa</option>
<option>Punjab</option>
<option>Rajasthan</option>
<option>Sikkim</option>
<option>Tamil Nadu</option>
<option>Tripura</option>
<option>Uttaranchal</option>
<option>Uttar Pradesh</option>
<option>Haryana</option>
<option>Himachal Pradesh</option>
<option>Chhattisgarh</option>
<option>Delhi</option>
</datalist>
</div><br><br><br>
<div id="left">
<label>Pincode </label>
        : <input type="number" name="pincode" id="pincode" placeholder="Enter your pincode" style="border-radius: 10px;">
</div>
<div id="right">
    <label>Landmark : </label>
<input type="text" name="landmark" id="Landmark" placeholder="Enter your landmark" style="border-radius: 10px;">
</div>
<div id="right">
<label>Mobile</label>
 : <input type="number" name="phonenumber" id="pnumber" placeholder="Enter your phonenumber" style="border-radius: 10px;">
</div><br><br><br>
<label>Annual Income  : </label>
      <input type="radio" id="annual income" name="annual income" value=" Below Rs. 1,00,000" class="one">
<label for="annual income">Below Rs. 1,00,000</label>
      <input type="radio" id="annual income" name="annual income" value=" Above Rs. 1,00,000" class="one">
<label for="annual income"> Above Rs. 1,00,000</label>
<br><br><br>
<center><font size="5em"><u> OCCUPATION</u></font></center><br><br>
<input type="radio" id="Occupation" name="Occupation" value="Agriculture" class="one">
<label for="Occupation">Agriculture </label>   
<input type="radio" id="Occupation" name="Occupation" value="Govt.employee" class="one">
<label for="Occupation">Govt.Employee </label>    
<input type="radio" id="Occupation" name="Occupation" value="Private employee" class="one">
<label for="Occupation">Private Employee</label>    
<input type="radio" id="Occupation" name="Occupation" value="self employee" class="one">
<label for="Occupation">Self Employed </label>   
<input type="radio" id="Occupation" name="Occupation" value="profesional" class="one">
<label for="Occupation">Profesional </label>    
<br><br>
<input type="radio" id="Occupation" name="Occupation" value="Others if any" class="one">
<label for="Occupation">Others if any</label>
    <input type="text" id="Occupation" name="Occupation" style="border-radius: 10px;">
<br><br><br>
<label>Height(in cm) : </label>
<input type="number" name="height" id="height" class="reading" style="border-radius: 10px;">
           <label>Weight(in kg) : </label>
<input type="number" name="Weight" id="Weight" class="reading" style="border-radius: 10px;">
           <label>Blood Pressure : </label>
<input type="number" name="bp" id="bp" class="reading" style="border-radius: 10px;">
           <label>Pulse : </label>
<input type="number" name="pulse" id="pulse" class="reading" style="border-radius: 10px;"> <br><br>
<label>Temp(in cels) : </label>
<input type="number" name="Temprature" id="Temprature" class="reading" style="border-radius: 10px;">
           <label>SpO2 : </label>
<input type="number" name="spo2" id="spo2" class="reading" style="border-radius: 10px;"> <br><br><br>
<label>Cheif Complaints : </label><br><br>
<textarea name="complaints" class="three" style="border-radius: 10px;"></textarea>
<br><br><br>
<label>Department : </label>
<input type="number" name="Department" id="Department" style="border-radius: 10px;">
<br><br><br><label>Hospital</label>
<input type="radio" id="Speciality Hospital" name="Hospital" value="Speciality Hospital" class="one">
<label for="Hospital">Specialty Hospital </label>   
<input type="radio" id="Medical College Hospital" name="Hospital" value="Medical College Hospital" class="one">
<label for="Hospital">Medical College Hospital </label><br><br><br>
<center>
<button id="button"><font color="white" >Submit</font></button>
</center>
</form>
</div>
</div>
</body>
</html>