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new-clinic.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" />
<title>Add New Clinic</title>
<link
href="https://cdn.jsdelivr.net/npm/[email protected]/dist/css/bootstrap.min.css"
rel="stylesheet"
integrity="sha384-QWTKZyjpPEjISv5WaRU9OFeRpok6YctnYmDr5pNlyT2bRjXh0JMhjY6hW+ALEwIH"
crossorigin="anonymous"
/>
<link rel="stylesheet" href="css/admin-styles.css" />
<link rel="stylesheet" href="css/admin-variables.css" />
<link rel="preconnect" href="https://fonts.googleapis.com" />
<link rel="preconnect" href="https://fonts.gstatic.com" crossorigin />
<link
href="https://fonts.googleapis.com/css2?family=Inter:[email protected]&display=swap"
rel="stylesheet"
/>
</head>
<body>
<!-- Empty Modal Div -->
<div id="modal-container"></div>
<header class="header-container">
<div class="nav">
<h3 class="nav-heading">Healthfort</h3>
<button class="btn btn-logout" id="logoutBtn">
<span class="icon-logout">
<svg
xmlns="http://www.w3.org/2000/svg"
width="24"
height="24"
fill="currentColor"
class="bi bi-box-arrow-right"
viewBox="0 0 16 16"
>
<path
fill-rule="evenodd"
d="M10 12.5a.5.5 0 0 1-.5.5h-8a.5.5 0 0 1-.5-.5v-9a.5.5 0 0 1 .5-.5h8a.5.5 0 0 1 .5.5v2a.5.5 0 0 0 1 0v-2A1.5 1.5 0 0 0 9.5 2h-8A1.5 1.5 0 0 0 0 3.5v9A1.5 1.5 0 0 0 1.5 14h8a1.5 1.5 0 0 0 1.5-1.5v-2a.5.5 0 0 0-1 0z"
/>
<path
fill-rule="evenodd"
d="M15.854 8.354a.5.5 0 0 0 0-.708l-3-3a.5.5 0 0 0-.708.708L14.293 7.5H5.5a.5.5 0 0 0 0 1h8.793l-2.147 2.146a.5.5 0 0 0 .708.708z"
/>
</svg>
</span>
Logout
</button>
</div>
<div class="back-to-dash mt-3">
<a
href="/index.html"
class="text-decoration-none d-flex align-items-center"
style="color: white"
>
<svg
xmlns="http://www.w3.org/2000/svg"
width="16"
height="16"
fill="currentColor"
class="bi bi-arrow-left mr-2 me-2"
viewBox="0 0 16 16"
>
<path
fill-rule="evenodd"
d="M15 8a.5.5 0 0 0-.5-.5H2.707l3.147-3.146a.5.5 0 1 0-.708-.708l-4 4a.5.5 0 0 0 0 .708l4 4a.5.5 0 0 0 .708-.708L2.707 8.5H14.5A.5.5 0 0 0 15 8"
/>
</svg>
Back
</a>
</div>
<div class="new-clinic-header">
<div class="header-content">
<p style="color: white">Add New Clinic</p>
</div>
</div>
</header>
<main>
<!-- Row 1 -->
<form id="newClinicForm" onsubmit="validateForm(event)">
<div class="add-clinic new-clinic-sub">
<p>Clinic Details</p>
<p class="mb-3" style="font-size: 0.85rem; color: var(--color-neutral)">
These details cannot be edited later!
</p>
<div class="input-container mb-3">
<div class="input-with-icon">
<input id="clinicName" type="text" placeholder="Clinic Name" />
</div>
<div class="global-error">
This field is mandatory.
</div>
</div>
<div class="input-four-grid mb-3">
<div class="input-container">
<div class="input-with-icon">
<select id="country">
<option value="" selected disabled>Country</option>
<option value="pin1">Country 1</option>
<option value="pin2">Country 2</option>
<option value="pin3">Country 3</option>
</select>
</div>
<div class="global-error">
This field is mandatory.
</div>
</div>
<div class="input-container">
<div class="input-with-icon">
<input id="pincode" type="text" placeholder="Pin Code" />
</div>
<div class="global-error">
This field is mandatory.
</div>
</div>
<div class="input-container">
<div class="input-with-icon">
<select id="state">
<option value="" selected disabled>State</option>
<option value="state1">State 1</option>
<option value="state2">State 2</option>
<option value="state3">State 3</option>
<!-- Add more options as needed -->
</select>
</div>
<div class="global-error">
This field is mandatory.
</div>
</div>
<div class="input-container">
<div class="input-with-icon">
<select id="city">
<option value="" selected disabled>City</option>
<option value="city1">City 1</option>
<option value="city2">City 2</option>
<option value="city3">City 3</option>
</select>
</div>
<div class="global-error">
This field is mandatory.
</div>
</div>
</div>
<div class="input-container">
<div class="input-with-icon">
<input id="address" type="text" placeholder="Address" />
</div>
<div class="global-error">
This field is mandatory.
</div>
</div>
</div>
<svg
xmlns="http://www.w3.org/2000/svg"
class="divider"
viewBox="0 0 942 2"
fill="none"
>
<path
d="M1 1H941"
stroke="black"
stroke-linecap="round"
stroke-linejoin="round"
stroke-dasharray="2 6"
/>
</svg>
<!-- Row 2 -->
<div class="add-admin new-clinic-sub">
<p>Admin Contact</p>
<p class="mb-3" style="font-size: 0.85rem; color: var(--color-neutral)">
Login link & password would be sent to the mentioned contact details.
Please confirm with the client for the following details.
</p>
<div class="input-four-grid mb-3">
<div class="input-container">
<div class="input-with-icon">
<input type="text" placeholder="Email ID" id="emailInput" />
</div>
<div id="emailError" class="error-message">
Please enter a valid email ID
</div>
<div class="global-error">
This field is mandatory.
</div>
</div>
<div class="input-container">
<div class="input-with-icon">
<input type="text" placeholder="Phone Number" id="phoneInput" />
</div>
<div id="phoneError" class="error-message">
Please enter a valid phone number
</div>
<div class="global-error">
This field is mandatory.
</div>
</div>
</div>
</div>
<svg
xmlns="http://www.w3.org/2000/svg"
class="divider"
viewBox="0 0 942 2"
fill="none"
>
<path
d="M1 1H941"
stroke="black"
stroke-linecap="round"
stroke-linejoin="round"
stroke-dasharray="2 6"
/>
</svg>
<!-- Row 3 -->
<div class="add-plan new-clinic-sub">
<p class="mb-3">Plan Details</p>
<div class="input-four-grid mb-3">
<div class="input-container">
<div class="input-with-icon">
<select id="category">
<option value="" selected disabled>Category</option>
<option value="cat1">Category 1</option>
<option value="cat2">Category 2</option>
<option value="cat3">Category 3</option>
<!-- Add more options as needed -->
</select>
</div>
<div class="global-error">
This field is mandatory.
</div>
</div>
<div class="input-container">
<div class="input-with-icon">
<select id="productPlan">
<option value="" selected disabled>Product Plan</option>
<option value="plan1">Plan 1</option>
<option value="plan2">Plan 2</option>
<option value="plan3">Plan 3</option>
<!-- Add more options as needed -->
</select>
</div>
<div class="global-error">
This field is mandatory.
</div>
</div>
<div class="input-container">
<div class="input-with-icon">
<input id="planStart" type="text" placeholder="Plan starts from" />
</div>
<div class="global-error">
This field is mandatory.
</div>
</div>
<div class="input-container">
<div class="input-with-icon">
<input id="planEnd" type="text" placeholder="Plan ends on" />
</div>
<div class="global-error">
This field is mandatory.
</div>
</div>
</div>
</div>
<svg
xmlns="http://www.w3.org/2000/svg"
class="divider"
viewBox="0 0 942 2"
fill="none"
>
<path
d="M1 1H941"
stroke="black"
stroke-linecap="round"
stroke-linejoin="round"
stroke-dasharray="2 6"
/>
</svg>
<!-- Row 4 -->
<div class="add-payment new-clinic-sub">
<p>Payment Details</p>
<p class="mb-3" style="font-size: 0.85rem; color: var(--color-neutral)">
Current status and details of payment from clinic
</p>
<div class="input-four-grid mb-3">
<div class="input-container">
<div class="input-with-icon">
<select id="paymentStatus">
<option value="" selected disabled>Payment Status</option>
<option value="ps1">1</option>
<option value="ps2">2</option>
<option value="ps3">3</option>
<!-- Add more options as needed -->
</select>
</div>
<div class="global-error">
This field is mandatory.
</div>
</div>
<div class="input-container">
<div class="input-with-icon">
<input id="lastPayment" type="text" placeholder="Last payment paid on" />
</div>
<div class="global-error">
This field is mandatory.
</div>
</div>
<div class="input-container">
<div class="input-with-icon">
<select id="paymentFrequency">
<option value="" selected disabled>Payment Frequency</option>
<option value="monthly">Monthly</option>
<option value="quarterly">Quarterly</option>
<option value="annually">Annually</option>
<!-- Add more options as needed -->
</select>
</div>
<div class="global-error">
This field is mandatory.
</div>
</div>
<div class="input-container">
<div class="input-with-icon">
<input id="nextPayment" type="text" placeholder="Next payment due on" />
</div>
<div class="global-error">
This field is mandatory.
</div>
</div>
</div>
</div>
<svg
xmlns="http://www.w3.org/2000/svg"
class="divider"
viewBox="0 0 942 2"
fill="none"
>
<path
d="M1 1H941"
stroke="black"
stroke-linecap="round"
stroke-linejoin="round"
stroke-dasharray="2 6"
/>
</svg>
<button
type="submit"
form="newClinicForm"
class="btn btn-new-clinic"
id="confirmChangesBtn"
style="margin: 1rem 4rem"
>
Add Clinic
</button>
</form>
</main>
<script
src="https://cdn.jsdelivr.net/npm/[email protected]/dist/js/bootstrap.bundle.min.js"
integrity="sha384-YvpcrYf0tY3lHB60NNkmXc5s9fDVZLESaAA55NDzOxhy9GkcIdslK1eN7N6jIeHz"
crossorigin="anonymous"
></script>
<!-- <script src="js/modal.js"></script> -->
<script src="js/new-clinic-validations.js"></script>
</body>
</html>