<commit_before><%@ page language="java" contentType="text/html; charset=UTF-8"
    pageEncoding="UTF-8"%>
<!DOCTYPE html PUBLIC "-//W3C//DTD HTML 4.01 Transitional//EN" "http://www.w3.org/TR/html4/loose.dtd">
<html>
<head>
	<meta http-equiv="Content-Type" content="text/html; charset=UTF-8">
	<title>Book Appointment - Patient Dashboard - Central Medic Center</title>
	<link rel="stylesheet" href="https://maxcdn.bootstrapcdn.com/bootstrap/3.3.7/css/bootstrap.min.css" integrity="<KEY>" crossorigin="anonymous">
	<link rel="stylesheet" href="css/dashboard.css">
	<link rel="stylesheet" href="css/patient.css">
</head>
<body>

<nav class="navbar navbar-inverse navbar-fixed-top">
  <div class="container-fluid">
    <div class="navbar-header">
      <button type="button" class="navbar-toggle collapsed" data-toggle="collapse" data-target="#navbar" aria-expanded="false" aria-controls="navbar">
        <span class="sr-only">Toggle navigation</span>
        <span class="icon-bar"></span>
        <span class="icon-bar"></span>
        <span class="icon-bar"></span>
      </button>
      <a class="navbar-brand" href="#">Central Medic Center</a>
    </div>
    <div id="navbar" class="navbar-collapse collapse">
      <ul class="nav navbar-nav navbar-right">
        <li><a href="#">Dashboard</a></li>
        <li><a href="#">Edit Profile</a></li>
        <li><a href="#">Logout</a></li>
      </ul>
      <form class="navbar-form navbar-right">
        <input type="text" class="form-control" placeholder="Search...">
      </form>
    </div>
  </div>
</nav>

<div class="container-fluid">
  <div class="row">
    <div class="col-sm-3 sidebar">
      <ul class="nav nav-sidebar">
        <li class="">
          
          <div class="row intro">
            <div class="col-sm-12 col-md-6 col-lg-4">
              <div class="">
                <img class="profilePic" src="media/user.png">
              </div>
            </div>
            <div class="col-sm-12 col-md-6 col-lg-8 info">
              <br><span class="name">Mr. <NAME></span><br>
              <img src="media/gender.png"><span class="details"> Male, 19 years</span><br>
              <img src="media/bloodGroup.png"><span class="blood"> A+</span><br>
              <img src="media/Location.png"><span class="location"> Jawahar Circle, Jaipur</span>
            </div>
          </div>

        </li>
        <li class="active"><a href="bookAppointment.jsp">Book Appointment</a></li>
        <li><a href="#">Upcoming Appointments</a></li>
        <li><a href="#">Appointment History</a></li>
      </ul>
    </div>
    <div class="col-sm-9 col-sm-offset-3 main">
      <h1 class="page-header">Book Appointment</h1>
      <form class="form-horizontal">
        <div class="row form-group">
            <label class="col-sm-2 control-label">Patient Name</label>
            <div class="col-sm-10">
              <p class="form-control-static"><NAME></p>
            </div>
        </div>
        <div class="form-group">
          <label for="inputEmail3" class="col-sm-2 control-label">Date</label>
          <div class="col-sm-10">
            <input type="email" class="form-control" id="inputEmail3" placeholder="Date">
          </div>
        </div>
        <div class="form-group">
          <label for="inputPassword3" class="col-sm-2 control-label">Symptons</label>
          <div class="col-sm-10">
            <textarea class="form-control" rows="2"></textarea>
          </div>
        </div>
        <div class="form-group">
          <label for="inputEmail3" class="col-sm-2 control-label">Suspected Disease</label>
          <div class="col-sm-10">
            <input type="email" class="form-control" id="inputEmail3" placeholder="Disease">
          </div>
        </div>
        <div class="form-group">
          <label for="exampleInputFile" class="col-sm-2 control-label">Medical Documents</label>
          <div class="col-sm-10">
            <input type="file" id="exampleInputFile">
            <p class="help-block">Upload relevant documents here for better care.</p>
          </div>
        </div>  
        <div class="form-group">
          <div class="col-sm-offset-6 col-sm-2">
            <button type="submit" class="btn btn-default">Submit</button>
          </div>
        </div>
      </form>
    </div>
  </div>
</div>

<!-- Bootstrap core JavaScript
================================================== -->
<!-- Placed at the end of the document so the pages load faster -->
<script src="https://ajax.googleapis.com/ajax/libs/jquery/1.12.4/jquery.min.js"></script>
<script>window.jQuery || document.write('<script src="../../assets/js/vendor/jquery.min.js"><\/script>')</script>
<script src="https://maxcdn.bootstrapcdn.com/bootstrap/3.3.7/js/bootstrap.min.js"></script>
</body>
</html><commit_msg>Corrected Booking Appointment<commit_after><%@ page language="java" contentType="text/html; charset=UTF-8"
    pageEncoding="UTF-8"%>
<!DOCTYPE html PUBLIC "-//W3C//DTD HTML 4.01 Transitional//EN" "http://www.w3.org/TR/html4/loose.dtd">
<html>
<head>
	<meta http-equiv="Content-Type" content="text/html; charset=UTF-8">
	<title>Book Appointment - Patient Dashboard - Central Medic Center</title>
	<link rel="stylesheet" href="https://maxcdn.bootstrapcdn.com/bootstrap/3.3.7/css/bootstrap.min.css" integrity="<KEY>" crossorigin="anonymous">
	<link rel="stylesheet" href="css/dashboard.css">
	<link rel="stylesheet" href="css/patient.css">
</head>
<body>

<nav class="navbar navbar-inverse navbar-fixed-top">
  <div class="container-fluid">
    <div class="navbar-header">
      <button type="button" class="navbar-toggle collapsed" data-toggle="collapse" data-target="#navbar" aria-expanded="false" aria-controls="navbar">
        <span class="sr-only">Toggle navigation</span>
        <span class="icon-bar"></span>
        <span class="icon-bar"></span>
        <span class="icon-bar"></span>
      </button>
      <a class="navbar-brand" href="#">Central Medic Center</a>
    </div>
    <div id="navbar" class="navbar-collapse collapse">
      <ul class="nav navbar-nav navbar-right">
        <li><a href="#">Dashboard</a></li>
        <li><a href="#">Edit Profile</a></li>
        <li><a href="#">Logout</a></li>
      </ul>
      <form class="navbar-form navbar-right">
        <input type="text" class="form-control" placeholder="Search...">
      </form>
    </div>
  </div>
</nav>

<div class="container-fluid">
  <div class="row">
    <div class="col-sm-3 sidebar">
      <ul class="nav nav-sidebar">
        <li class="">
          
          <div class="row intro">
            <div class="col-sm-12 col-md-6 col-lg-4">
              <div class="">
                <img class="profilePic" src="media/user.png">
              </div>
            </div>
            <div class="col-sm-12 col-md-6 col-lg-8 info">
              <br><span class="name">Mr. <NAME></span><br>
              <img src="media/gender.png"><span class="details"> Male, 19 years</span><br>
              <img src="media/bloodGroup.png"><span class="blood"> A+</span><br>
              <img src="media/Location.png"><span class="location"> Jawahar Circle, Jaipur</span>
            </div>
          </div>

        </li>
        <li class="active"><a href="bookAppointment.jsp">Book Appointment</a></li>
        <li><a href="#">Upcoming Appointments</a></li>
        <li><a href="#">Appointment History</a></li>
      </ul>
    </div>
    <div class="col-sm-9 col-sm-offset-3 main">
      <h1 class="page-header">Book Appointment</h1>
      <form class="form-horizontal">
        <div class="form-group">
          <label for="name" class="col-sm-2 control-label">Patient Name</label>
          <div class="col-sm-10">
            <p class="form-control-static"><NAME></p>
          </div>
        </div>
        <div class="form-group">
          <label for="date" class="col-sm-2 control-label">Date</label>
          <div class="col-sm-10">
            <input type="date" class="form-control" id="date" placeholder="Date">
          </div>
        </div>
        <div class="form-group">
          <label for="symptons" class="col-sm-2 control-label">Symptons</label>
          <div class="col-sm-10">
            <textarea class="form-control" rows="2" placeholder="Symptons"></textarea>
          </div>
        </div>
        <div class="form-group">
          <label for="disease" class="col-sm-2 control-label">Suspected Disease</label>
          <div class="col-sm-10">
            <input type="email" class="form-control" id="disease" placeholder="Disease">
          </div>
        </div>
        <div class="form-group">
          <label for="Documents" class="col-sm-2 control-label">Medical Documents</label>
          <div class="col-sm-10">
            <input type="file" id="Documents">
            <p class="help-block">Upload relevant documents here for better care.</p>
          </div>
        </div>  
        <div class="form-group">
          <div class="col-sm-offset-6 col-sm-2">
            <button type="submit" class="btn btn-default">Submit</button>
          </div>
        </div>
      </form>
    </div>
  </div>
</div>

<!-- Bootstrap core JavaScript
================================================== -->
<!-- Placed at the end of the document so the pages load faster -->
<script src="https://ajax.googleapis.com/ajax/libs/jquery/1.12.4/jquery.min.js"></script>
<script>window.jQuery || document.write('<script src="../../assets/js/vendor/jquery.min.js"><\/script>')</script>
<script src="https://maxcdn.bootstrapcdn.com/bootstrap/3.3.7/js/bootstrap.min.js"></script>
</body>
</html>
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