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organ_requests.php
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organ_requests.php
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<?php
$user = $_REQUEST['EMAIL'];
?>
<!DOCTYPE html>
<html lang="en">
<head>
<meta charset="UTF-8">
<meta http-equiv="X-UA-Compatible" content="IE=edge">
<meta name="viewport" content="width=device-width, initial-scale=1.0">
<title>Request For Organ</title>
</head>
<body>
<div class="header ">
<img class="img-log" src="images/request.png" alt="new user icon">
<div class="h2">
<h3 CLASS="h3">Request For Organ</h3>
</div>
</div>
<?php
$query1 = "SELECT * FROM registration WHERE EMAIL = '$user'";
$con = new mysqli('localhost','root','', 'organdb');
$values = mysqli_query($con, $query1);
$id = "";
while ($row = mysqli_fetch_assoc($values)) {
$id = $row['REGISTRATION_ID'];
}
if(isset($_POST['submit'])) {
$ORGAN_TYPE = $_POST['ORGAN_TYPE'];
$QUANTITY = $_POST['QUANTITY'];
$BLOOD_GROUPn = $_POST['BLOOD_GROUPn'];
$REQUEST_TYPE = $_POST['REQUEST_TYPE'];
$ADD_RESSn = $_POST['ADD_RESSn'];
$ZIP_CODE = $_POST['ZIP_CODE'];
$PhoneN = $_POST['phoneN'];
$con = new mysqli('localhost','root','','organdb');
$stmt = $con->prepare("INSERT INTO organ_requests(REGISTRATION_ID,ORGAN_TYPE,QUANTITY,BLOOD_GROUPn,REQUEST_TYPE,ADD_RESSn,ZIP_CODE,phoneN)
values(?,?,?,?,?,?,?,?)");
$stmt->bind_param("isisssis",$id,$ORGAN_TYPE,$QUANTITY,$BLOOD_GROUPn,$REQUEST_TYPE,$ADD_RESSn,$ZIP_CODE,$PhoneN);
$stmt->execute();
// echo "Registered Succesfull";
$stmt->close();
$con->close();
?>
<div class="alert alert-success" role="alert">
<h4 style="color:#fcc358;text-align:center;"> Your request has been Added successfully.</h4>
</div>
<?php
}
?>
<form action = "" method = "post" name = "myform" class = "form-group">
<!-- Imported from -->
<div class="wrapper">
<div class="title">
Request Now
</div>
<div class="form">
<div class="inputfield">
<label for="request-select" >Organ Type</label>
<div class="custom_select">
<select name=" ORGAN_TYPE" id="request-select" required>
<option value="">Select</option>
<option value="Heart">Heart</option>
<option value="Kidneys">Kidneys</option>
<option value="Liver">Liver</option>
<option value="Lungs">Lungs</option>
<option value="Pancreas">Pancreas</option>
<option value="Intestines">Intestines</option>
<option value="Eye">Eye</option>
<option value="Heart valves">Heart valves</option>
</select>
</div>
</div>
<div class="inputfield">
<label for="quantity-select" >Select Quantity</label>
<div class="custom_select">
<select name="QUANTITY" id="quantity-select" required>
<option value="">Select</option>
<option value="1">1</option>
<option value="2">2</option>
<option value="3">3</option>
<option value="4">4</option>
<option value="5">5</option>
<option value="6">6</option>
<option value="7">7</option>
</select>
</div>
</div>
<div class="inputfield">
<label for="blood-select" >Blood Group</label>
<div class="custom_select">
<select name=" BLOOD_GROUPn" id="blood-select" required>
<option value="">Select</option>
<option value="A+">A+</option>
<option value="A-">A-</option>
<option value="B+">B+</option>
<option value="B-">B-</option>
<option value="AB+">AB+</option>
<option value="AB-">AB-</option>
<option value="O+">O+</option>
<option value="O-">O-</option>
</select>
</div>
</div>
<div class="inputfield">
<label for="situation-select">Request Type</label>
<div class="custom_select" required>
<select name="REQUEST_TYPE" id="situation-select" required>
<option value="">Select</option>
<option value="Emergency">Emergency</option>
<option value="Not Emergency"> Not Emergency</option>
</select>
</div>
</div>
<div class="inputfield">
<label for="ADD_RESSn">Address</label>
<input type="text" class="input" id ="ADD_RESSn" name="ADD_RESSn" required>
</div>
<div class="inputfield">
<label for="zipcode">Zip Code</label>
<input type="text" class="input" id= "zipcode" name="ZIP_CODE" required>
</div>
<div class="inputfield">
<label for="phoneN">Phone Number</label>
<input type="text" class="input" id ="phoneN" name="phoneN" required>
</div>
<div class="inputfield terms">
<label for="checkbox" class="check">
<input type="checkbox" id= "checkbox" required>
<span class="checkmark"></span>
</label>
<p>Agreed to terms and conditions</p>
</div>
<div class="inputfield">
<input type="submit" name="submit" value="Submit" class="btn">
</div>
<p class="alter" > Go BACK TO HOME? <a class= "home" href="logged_in.php?EMAIL=<?php echo $user ?>">Home</a></p>
</div> <!--class= alter-login -->
</div>
</form>
</body>
</html>
<style>
@import url('https://fonts.googleapis.com/css?family=Montserrat:400,700&display=swap');
*{
margin: 0;
padding: 0;
box-sizing: border-box;
font-family: 'Montserrat', sans-serif;
}
.header {
padding: 25px;
text-align: center;
background: #fcc358;
color: white;
font-size: 30px;
}
body{
background: #fff;
padding: 0 0px;
}
.header .h3 {
color: #fff;
font-size: 30px
}
.header .img-log{
position: relative;
left: 20px;
width:180px;
height:180px;
}
.wrapper{
max-width: 700px;
width: 100%;
background: #FFF5EE;
margin: 50px auto;
box-shadow: 2px 2px 4px rgba(0,0,0,0.125);
padding: 30px;
}
.wrapper .title{
font-size: 24px;
font-weight: 700;
margin-bottom: 25px;
color: #fcc358;
text-transform: uppercase;
text-align: center;
}
.wrapper .form{
width: 100%;
}
.wrapper .form .inputfield{
margin-bottom: 15px;
display: flex;
align-items: center;
}
.wrapper .form .inputfield label{
width: 200px;
color: #757575;
margin-right: 10px;
font-size: 14px;
}
.wrapper .form .inputfield .input {
width: 100%;
outline: none;
border: 1px solid #d5dbd9;
font-size: 15px;
padding: 8px 10px;
border-radius: 3px;
transition: all 0.3s ease;
}
.wrapper .form .inputfield .custom_select{
position: relative;
width: 100%;
height: 37px;
}
.wrapper .form .inputfield .custom_select:before{
content: "";
position: absolute;
top: 12px;
right: 10px;
border: 8px solid;
border-color: #d5dbd9 transparent transparent transparent;
pointer-events: none;
}
.wrapper .form .inputfield .custom_select select{
-webkit-appearance: none;
-moz-appearance: none;
appearance: none;
outline: none;
width: 100%;
height: 100%;
border: 0px;
padding: 8px 10px;
font-size: 15px;
border: 1px solid #fcc358;
border-radius: 3px;
}
.wrapper .form .inputfield .input:focus,
.wrapper .form .inputfield .textarea:focus,
.wrapper .form .inputfield .custom_select select:focus{
border: 1px solid #39ace7;
}
.wrapper .form .inputfield p{
font-size: 14px;
color: #757575;
}
.wrapper .form .inputfield .check{
width: 15px;
height: 15px;
position: relative;
display: block;
cursor: pointer;
}
.wrapper .form .inputfield .check input[type="checkbox"]{
position: absolute;
top: 0;
left: 0;
opacity: 0;
}
.wrapper .form .inputfield .check .checkmark{
width: 15px;
height: 15px;
border: 1px solid #fcc358;
display: block;
position: relative;
}
.wrapper .form .inputfield .check .checkmark:before{
content: "";
position: absolute;
top: 1px;
left: 2px;
width: 5px;
height: 2px;
border: 2px solid;
border-color: transparent transparent #fff #fff;
transform: rotate(-45deg);
display: none;
}
.wrapper .form .inputfield .check input[type="checkbox"]:checked ~ .checkmark{
background: #fcc358;
}
.wrapper .form .inputfield .check input[type="checkbox"]:checked ~ .checkmark:before{
display: block;
}
.wrapper .form .inputfield .btn{
width: 100%;
padding: 8px 10px;
font-size: 15px;
border: 0px;
background: #fcc358;
color: #fff;
cursor: pointer;
border-radius: 3px;
outline: none;
}
.wrapper .form .inputfield .btn:hover{
background: #ffbb00;
}
.wrapper .form .inputfield:last-child{
margin-bottom: 0;
}
.wrapper .form .alter{
text-align: center;
}
.wrapper .form .alter .register, .wrapper .form .alter .home{
text-decoration: none;
padding: 10px;
margin: 10px;
color:#ffbb00;
}
@media (max-width:420px) {
.wrapper .form .inputfield{
flex-direction: column;
align-items: flex-start;
}
.wrapper .form .inputfield label{
margin-bottom: 5px;
}
.wrapper .form .inputfield.terms{
flex-direction: row;
}
}
</style>