forked from Ratan5545/Hospital_management_system
-
Notifications
You must be signed in to change notification settings - Fork 0
/
Copy pathInsurance Policy.html
67 lines (46 loc) · 1.57 KB
/
Insurance Policy.html
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
<!DOCTYPE html>
<html lang="en">
<head>
<meta charset="UTF-8">
<title >Insurance Policy Form</title>
<link rel="stylesheet" href="Insurance Policy.css">
</head>
<body>
<h1>Insurance Policy Form</h1>
<form action="insert_Insurance Policy.PHP" method="post">
<label for="policy-number">Policy Number:</label>
<input type="text" id="policy-number" name="policy-number" required>
<label for="Insurance Network">Insurance Network:</label>
<input type="text" id="Insurance Network" name="Insurance Network" required>
<label for="policy-name">Policy Name:</label>
<input type="text" id="policy-number" name="policy-name" required>
<label for="Description">Description</label>
<input type="text" id="Description" name="Description" required>
<label for="policy-duration">Deductible:</label>
<input type="text" id="Deductible" name="Deductible" required>
<label for="insurance-amount">C0-Pay:</label>
<input type="text" id="C0-Pay" name="C0-Pay" required>
<button type="submit" style=
"display: inline-block;
padding: 10px;
background-color: #4CAF50;
color: white;
text-decoration: none;
border-radius: 10px;">Payment</button>
</form>
<!DOCTYPE html>
<html>
<head>
<title>Background with two images</title>
<style>
body {
background-image: url(health-insurance-policy-myths.jpg), url(HealthInsurance.jpg);
background-position: left bottom, right bottom;
background-repeat: no-repeat;
background-size: auto 50%;
}
</style>
</head>
</html>
</body>
</html>