form.html

<h2>Medical Form</h2>
<link rel="stylesheet" href="https://cdn.jsdelivr.net/npm/water.css@2/out/water.css">

<form name='medform' action='form1.php' method='post'>
<div>
             <b>First Name</b><input type="text" name="first_name"></input>
            <b>Second Name</b><input type="text" name="last_name"></input>
</div><br>
<div>
<label><b>Gender</b></label><br>
<label>
    <input type="radio" name="gender" value="male"> Male
  </label>
  <label>
    <input type="radio" name="gender" value="female"> Female
  </label>

</div><br>
<div><br>
<label><b>Department</b></label><br>
	<label>
			<input type="checkbox" name="department" value="inpatient"> In Patient
		</label><br>
		<label>
			<input type="checkbox" name="department" value="outpatient"> Out Patient
		</label><br>
             </div><br>
<div><br>
<b>Doctor's Name</b><input type="text" name="doc_name"></input>
</div><br>
<div>
<b>Appointment Date</b><input type="date" name="date"><br><br>
<b>Appointment Time</b><input type="time" id="time" name="time">
</div><br>
<div>
<b>Payment Mode</b><select name="payment">
              <option>Cash</option>
              <option>Card</option>
              <option>M-Pesa</option>
</select>
</div><br>
<div>
<label><b>Consultation Fee</b></label><br>
<input type="text" name="consult_fee">
</div><br>
<div>
<label><b>Medical Fee</b></label><br>
<input type="text" name="med_fee">
</div><br>
<div>
<label><b>Pharmacy</b></label><br>
<input type="text" name="pharm_fee">
</div><br>

<div>
<b>Upload Insurance Card</b><br><input type="file" id="file" name="file"><br>
                    

</div><br>
<div>
<label><b>Comments</b></label><br>
<textarea  rows="10" cols="50" name="comments"></textarea><br>
</div><br>
<div>
<input type='submit' value='submit order'>
<input type='reset' value='reset form'>
</div><br><br>

</form>