Bell/info.html at master · GirlsFirst/Bell · GitHub

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<!DOCTYPE html>
<html>
<head>
  <link rel="stylesheet" type="text/css" href="file:///Users/kellyrita/Documents/design.css">
  <script src="file:///Users/kellyrita/Documents/tabs.js"></script>
  <style>
table, th, td {
border: 1px solid black;
border-collapse: collapse;
}
th, td {
padding: 15px;
}
</style>
</head>
<body>
  <center><img src="file:///Users/kellyrita/Downloads/bell2.png" alt="bell logo" width="652" height="336" border="0"/></center>
  <div class="tab">
    <button class="tablinks" onclick="openCity(event, 'Home')"><a href="file:///Users/kellyrita/Documents/homepage.html">Home</a></button>
    <button class="tablinks" onclick="openCity(event, 'My information')">My Info</button>
    <button class="tablinks" onclick="openCity(event, 'Helping Hands')"><a href="file:///Users/kellyrita/Documents/helping.html">Helping Hands</a></button>
    <button class="tablinks" onclick="openCity(event, 'Meals on Wheels')"><a href="file:///Users/kellyrita/Documents/meals_wheels.html">Meals on Wheels</a></button>
    <button class="tablinks" onclick="openCity(event, 'Prescriptions and Appts')"><a href="file:///Users/kellyrita/Documents/appt.html">Prescriptions and Appts</a></button>
    <button class="tablinks" onclick="openCity(event, 'Get Involved')"><a href="file:///Users/kellyrita/Documents/get_involved.html">Get Involved</a></button>
    <button class="tablinks" onclick="openCity(event, 'Connect With Others!')"><a href="file:///Users/kellyrita/Documents/connect.html">Connect With Others!</a></button>
  </div>

  <center><h1>My Info Section</h1></center>

  <div class="row">
  <div class="column">
  <center><p>By filling out the table to the right as accurately as possible,
    the creators at Bell can help you navigate through your day easier! We can
    ensure your information is secure and completely confidential, and only
    accessible to our devoted and professional team. In the case your information
    changes, you can easily edit the form below to make sure it is as updated as possible!</p></center>
    </div>
    <div class="column">
    <center><img src="file:///Users/kellyrita/Downloads/pill.jpg" width="408" length="272" border="1"/></center>
    <br />
    </div>

<hr />

  <form name="information" action="bell.inquires@gmail.com?subject=My Information Form" method="post" enctype="text/plain">
    <br />
  <center><b><h1>Information Form</h1></b></center>
  <fieldset>
<legend><p align="left"><b>Personal Information:</b></p></legend>
<p align="left">
      First Name:
 <input name="firstname" type="text" size="25">

 Middle Initial:
 <input name="mi" type="text">
 <!--Make this box smaller-->

 Last Name:
 <input name="mi" type="text" size="25">
<br />
<br />
 D.O.B
 <input name="dob" type="text">
<br />
<br />
 Email:
 <input name="email" type="text">
<br><br>
 Address:
 <input name="add" type="text">

 City:
 <input name="city" type="text">

 State:
 <input name="state" type="text">
 <br><br>
 <!--Make this box smaller-->
</fieldset>

<fieldset>
<legend><p align="left"><b>Medical Information:</b></p></legend>
<p align="left">
Doctor's Name:
 <input name="docname" type="text">

 Doctor's Phone Number:
 <input name="phone#" type="text"><br /><br />
<!--Make this box just a bit smaller-->
 Hospital/Clinic Address:
 <input name="hospadd" type="text">
 <br><br>

 What Medications Do You Take?:
 <input name="meds" type="text">


 <p align= "left"> Please List Any Conditions You Have:</p>
 <p align="left"> <textarea name="conditions" rows="10" cols="60"></textarea></p>
 <!--You can change the size of the box if it looks dumb-->
 </fieldset>
 <div class="vl"></div>

<div>
  <fieldset>
  <legend><p align="left"><b> Add To Your Daily Log!</b></p></legend>
<table width="760">
<tr>
  <th><center><p><b>Today Has Been →</b></p><br /></center></th>
    <br />
    <th><img src="file:///Users/kellyrita/Downloads/happy.png" alt="happy face" width="256" height="256" />
    <input type="radio" name="emotion" value="happy"> Good<br></th>
    <th><img src="file:///Users/kellyrita/Downloads/eh.png" alt="straight face" width="256" height="256" />
    <input type="radio" name="emotion" value="eh"> Indifferent/Calm<br></th>
    <th><img src="file:///Users/kellyrita/Downloads/sad2.png" alt="sad face" width="256" height="256" />
    <input type="radio" name="emotion" value="sad">Bad</th>
 </tr>
  </table>

    <p align="left"> Have You Taken Your Medications Today?<br> <input name="medis" type="text"></p><br />
    <p align="left"> Did You Need Assistance From Our Helping Hands Today?<br> <input name="assist" type="text"></p><br />
    <p align="left"> How Did You Sleep Last Night?<br> <input name="sleep" type="text"></p><br />
    <p align="left"> How Are You Feeling Today?<br><input name="feeling" type="text"></p><br />
       <!--Possibly insert emoji's here??-->

       <!--There is a biggg space before first name that has o be fixed in CSS-->

<p align="left" type="text" width="150%"> <input type="submit" value="Submit My Information">
  </fieldset>
</form>

  </body>