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feedback.html
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feedback.html
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<html>
<head>
<title>MedicInfo | FeedBack</title>
<link rel="stylesheet" type="text/css" href="Header.css"/>
<link rel="stylesheet" type="text/css" href="feedback.css"/>
<meta charset="utf-8"/>
</head>
<body>
<div class="border"></div>
<div class="medictab">
<h3>MedicInfo <p style="text-decoration:none;">Saving Lives | Protecting People | Sharing Knowledge</p></h3>
<form>
<input type="text" name="search" placeholder="Search MedicInfo..." size="30"/>
<input type="submit" value="Search" />
</form>
</div>
<div class="navigation">
<ul>
<li><a href="index.html">Home</a></li>
<li class="dropdown">
<a href="quiz.html" class="dropbtn">Quizzes</a>
<div class="dropctn">
<a href="diseasequiz.html">Quiz on Diseases</a>
<a href="medicinequiz.html">Quiz on Medicines</a>
</div>
</li>
<li class="dropdown">
<a href="disease.html" class="dropbtn">Diseases</a>
<div class="dropctn">
<a href="adeno.html">Adenovirus Infection</a>
<a href="sleepsick.html">Sleeping Sickness</a>
<a href="arthritis.html">Arthritis</a>
<a href="disease.html">More...</a>
</div>
</li>
<li class="dropdown">
<a href="medicine.html" class="dropbtn">Medicines</a>
<div class="dropctn">
<a href="">Vitamin B12</a>
<a href="">Metformin</a>
<a href="">Analgesics</a>
<a href="medicine.html">More...</a>
</div>
</li>
<li><a href="sympcheck.html">Symptom Checker</a></li>
<li><a href="about.html">About Us</a></li>
</ul>
</div>
<br/>
<p id="toppara">
"We all need people who will give us feedback. That's how we improve."<br/>
<span style="font-size: 18px; float: right;">---Bill Gates---</span>
</p>
<br/>
<form name="regform" method="post" class="formcss" autocomplete="off">
<fieldset>
<legend style="letter-spacing: 1px; font-family: Helvetica; font-size: 20px; color: #C40000; font-weight: bold;">FeedBack For MedicInfo</legend>
<span>(* Required)</span><br/><br/>
<sup><span>*</span></sup>Name : <br/>
<input type="text" name="fname" value="" placeholder="First Name / UserName" title="Enter your First name" /> 
<input type="text" name="lname" value="" placeholder="Last Name" title="Enter your Last name"><br>
<span id="fnameerr"></span> 
<span id="lnameerr"></span><br/>
<sup><span>*</span></sup>Email Address : <br/><input type="email" name="email" value="" placeholder="Enter your E-mail" title="Enter Valid E-Mail" /><br><span id="emailerr"></span><br/>
<!--Date Of Birth (optional) : <br/><br/><input type="date" name="dob"/><br><span id="doberr"></span><br/>-->
<sup><span>*</span></sup>Age : <br/>
<input type="number" name="age" value="" min="12" required="required" placeholder="Enter Your Age" /><br/><span id="ageerr"></span><br/>
<sup><span>*</span></sup>Sex :<br><label for="male" style="font-size: 16px;">Male</label><input type="radio" name="sex" id="male" value="male">
<label for="female" style="font-size: 16px;">Female</label><input type="radio" name="sex" id="female" value="female">
<br/><span id="sexerr"></span><br/>
<sup><span>*</span></sup>Blood Group : <br/><input list="bloodgrp" name="bldgroup" placeholder="Your Blood Group" title="Enter your Blood Group" /><br><span id="bldgerr"></span><br/>
<datalist id="bloodgrp">
<option>A+</option>
<option>A-</option>
<option>B+</option>
<option>B-</option>
<option>O+</option>
<option>O-</option>
<option>AB+</option>
<option>AB-</option>
</datalist>
<sup><span>*</span></sup>How's Your Experience with MedicInfo?<br/>
<input type="radio" name="experience" id="poor"/><label for="poor">Poor</label><br/>
<input type="radio" name="experience" id="average"/><label for="average">Average</label><br/>
<input type="radio" name="experience" id="good" checked="checked" /><label for="good">Good</label><br/>
<input type="radio" name="experience" id="excellent"/><label for="excellent">Excellent</label><br/><br/>
<sup><span>*</span></sup>Rate our Symptom Checker :<br/>
<input type="number" name="rating" min="0" max="10" value="6" /><span style="font-size: 12px; color: black;">(Between 0(not satisfactory) to 10(Amazing))</span><br/><br/>
Any extra Comments and FeedBack : <br/>
<textarea rows="8" cols="30" style="font-family: Helvetica; font-size: 14px;"></textarea>
<br/><br/>
<input type="submit" name="submit" value="Submit FeedBack" onclick="return validate(this.form)" /> 
<input type="reset" name="Reset" value="Clear All" onclick="return resetValues()" />
</fieldset>
</form>
<script type="text/javascript">
var refname = document.getElementById("fnameerr");
var relname = document.getElementById("lnameerr");
var reemail = document.getElementById("emailerr");
//var redob = document.getElementById("doberr");
var reage = document.getElementById("ageerr");
var regen = document.getElementById("sexerr");
var rebldg = document.getElementById("bldgerr");
function validate(form) {
// body...
var text = "";
if (form.fname.value=="" ) {
text = "First name cannot be empty";
refname.innerHTML = text;
form.fname.value = "";
return false;
}
if(form.fname.value.match(/[0-9]/)) {
text = "First name cannot contain numbers";
refname.innerHTML = text;
form.fname.value = "";
return false;
}
if(form.fname.value!="" && !form.fname.value.match(/[0-9]/)) {
refname.innerHTML = "";
}
if (form.lname.value=="" ) {
text = "Last name cannot be empty";
relname.innerHTML = text;
form.lname.value = "";
return false;
}
if(form.lname.value.match(/[0-9]/)) {
text = "Last name cannot contain numbers";
relname.innerHTML = text;
form.lname.value = "";
return false;
}
if(form.lname.value!="" && !form.lname.value.match(/[0-9]/)) {
relname.innerHTML = "";
}
if(form.email.value=="" || form.email.value.indexOf('@',0)==-1 || form.email.value.indexOf('.')==-1 || form.email.value.indexOf('.')==0) {
text = "Enter valid E-mail";
reemail.innerHTML = text;
form.email.value = "";
return false;
}
if(form.email.value!="" && form.email.value.indexOf('@',0)!=-1 && form.email.value.indexOf('.')!=-1 && form.email.value.indexOf('.')!=0) {
reemail.innerHTML = "";
}
if(form.age.value=="" || form.age.value<12)
{
reage.innerHTML = "Enter Age within specific limits, greater than 12";
return false;
}
if(form.age.value>12)
{
reage.innerHTML = "";
}
if (form.sex[0].checked==false && form.sex[1].checked==false) {
text = "Please choose your Sex (Gender)";
regen.innerHTML = text;
return false;
}
if (form.sex[0].checked==true || form.sex[1].checked==true) {
regen.innerHTML = "";
}
if (form.bldgroup.value=="") {
text = "Blood Group cannot be empty";
rebldg.innerHTML = text;
form.bldgroup.value = "";
return false;
}
if (!form.bldgroup.value.match(/^(A|B|O|AB)[+-]$/)) {
text = "Enter Valid Blood Group";
rebldg.innerHTML = text;
form.bldgroup.value = "";
return false;
}
if (form.bldgroup.value.match(/^(A|B|O|AB)[+-]$/)) {
rebldg.innerHTML = "";
}
alert("Form Submitted");
return true;
}
function resetValues()
{
refname.innerHTML = "";
relname.innerHTML = "";
reemail.innerHTML = "";
regen.innerHTML = "";
rebldg.innerHTML = "";
reage.innerHTML = "";
return true;
}
</script>
<br/><br/><br/><br/><br/><br/>
<div id="footer">
<p style="text-align: center; font-size: 11px;">Thank you for visiting</p>
<p style="text-align: center;">MEDICINFO</p>
<p style="font-size: 11px; text-align: center;"><abbr title="[email protected]">Contact Us</abbr> | Visit Again | Stay Healthy | <a href="feedback.html" style="font-size: 11px;">FeedBack</a></p>
<hr/>
<p style="color: #DCFFFE; margin-left: 10px; font-size: 19px;">Maintained By: -
<ul id="credits">
<li>Kunal</li>
<li>Kanishk</li>
<li>Siddharth</li>
</ul></p>
</div>
</body>
</html>