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<%@ Page Title="" Language="C#" MasterPageFile="~/admin/main.Master" AutoEventWireup="true" CodeBehind="Registration_form.aspx.cs" Inherits="VGM.admin.Registration_form" %> <asp:Content ID="Content1" ContentPlaceHolderID="head" runat="server"> </asp:Content> <asp:Content ID="Content2" ContentPlaceHolderID="ContentPlaceHolder1" runat="server"> <form runat="server"> <div class="content-wrapper"> <div class="container"> <div class="header">Registration Form</div> <div class="form-row"> <div class="col-md-4"> <!-- Tag No. --> <div class="form-group"> <label for="tagNo">Registration Date</label> <asp:TextBox ID="TextBox1" runat="server" TextMode="Date" CssClass="form-control" /> <asp:RequiredFieldValidator ID="RequiredFieldValidator4" runat="server" SetFocusOnError="true" ControlToValidate="TextBox1" ValidationGroup="purchase" ErrorMessage="Please enter Tag no." ForeColor="#ff0000"></asp:RequiredFieldValidator> </div> </div> <div class="col-md-4"> <!-- Tag No. --> <div class="form-group"> <label for="tagNo">Tag No. of the Animal (if available)</label> <asp:TextBox ID="txtTagNo" runat="server" CssClass="form-control" /> <asp:RequiredFieldValidator ID="RequiredFieldValidator1" runat="server" SetFocusOnError="true" ControlToValidate="txtTagNo" ValidationGroup="purchase" ErrorMessage="Please enter Tag no." ForeColor="#ff0000"></asp:RequiredFieldValidator> </div> </div> <!-- Column 1 --> <div class="col-md-4"> <div class="form-group"> <label for="animalCategory">Animal Category</label> <asp:DropDownList ID="comboBox1" AppendDataBoundItems="true" CssClass="form-control" runat="server"> <asp:ListItem Text="Select Animal Category" Value="" /> </asp:DropDownList> <asp:RequiredFieldValidator ID="RequiredFieldValidator2" runat="server" SetFocusOnError="true" ControlToValidate="comboBox1" ValidationGroup="purchase" ErrorMessage="Please enter Select Category" ForeColor="#ff0000"></asp:RequiredFieldValidator> </div> </div> <div class="col-md-4"> <!-- How the Animal Arrived --> <div class="form-group"> <label for="arrivalMethod">How the Animal Arrived</label> <asp:DropDownList ID="comboBox2" runat="server" CssClass="form-control"> <asp:ListItem Text="Select Arrival Method" Value="" /> <asp:ListItem Text="With Owner" Value="With Owner" /> <asp:ListItem Text="Hospital Ambulance" Value="Hospital Ambulance" /> <asp:ListItem Text="Stranger from the Street" Value="Stranger from the Street" /> <asp:ListItem Text="With Owner and Hospital Ambulance" Value="With Owner and Hospital Ambulance" /> <asp:ListItem Text="Other" Value="Other" /> </asp:DropDownList> <asp:RequiredFieldValidator ID="RequiredFieldValidator3" runat="server" SetFocusOnError="true" ControlToValidate="comboBox2" ValidationGroup="purchase" ErrorMessage="Please enter Arrival" ForeColor="#ff0000"></asp:RequiredFieldValidator> </div> </div> <div class="col-md-4"> <div class="form-group"> <label for="speciesBreed">Species/Breed</label> <asp:TextBox ID="txtSpeciesBreed" runat="server" CssClass="form-control" /> </div> </div> <div class="col-md-4"> <div class="form-group"> <label for="arrivalMethod">Disease Category</label> <asp:DropDownList ID="category" runat="server" CssClass="form-control"> <asp:ListItem Text="Select Disease Category" Value="0" /> <asp:ListItem Text="Paralaysis" Value="1" /> <asp:ListItem Text="Blind" Value="2" /> </asp:DropDownList> </div> </div> <div class="col-md-4"> <div class="form-group"> <label for="gender">Gender</label> <asp:DropDownList ID="comboBox3" runat="server" CssClass="form-control"> <asp:ListItem Text="Select Gender" Value="" /> <asp:ListItem Text="Male" Value="Male" /> <asp:ListItem Text="Female" Value="Female" /> <asp:ListItem Text="Other" Value="Other" /> </asp:DropDownList> </div> </div> <div class="col-md-4"> <!-- Color/Markings --> <div class="form-group"> <label for="colorMarkings">Color/Markings</label> <asp:TextBox ID="txtColorMarkings" runat="server" CssClass="form-control" /> </div> </div> <div class="col-md-4"> <!-- Weight --> <div class="form-group"> <label for="weight">Weight (in kg)</label> <asp:TextBox ID="txtWeight" runat="server" CssClass="form-control" /> </div> </div> <div class="col-md-4"> <div class="form-group"> <label for="diseaseDiagnosis">Disease Diagnosis</label> <asp:TextBox ID="txtDiseaseDiagnosis" runat="server" CssClass="form-control" /> </div> </div> <div class="col-md-4"> <div class="form-group"> <label for="prognosis">Prognosis</label> <asp:TextBox ID="txtPrognosis" runat="server" CssClass="form-control" /> </div> </div> <div class="col-md-4"> <div class="form-group"> <label for="prognosis">Assign To</label> <asp:TextBox ID="AssignedTo" runat="server" CssClass="form-control" /> </div> </div> </div> <div class="form-row"> <!-- Column 2 --> <div class="col-md-6"> <!-- Owner Information --> <h4>Owner Information</h4> <div class="form-group"> <label for="ownerFullName">Full Name</label> <asp:TextBox ID="txtOwnerFullName" runat="server" CssClass="form-control" /> </div> <div class="form-group"> <label for="ownerMobile">Mobile</label> <asp:TextBox ID="txtOwnerMobile" runat="server" CssClass="form-control" /> </div> <div class="form-group"> <label for="ownerAddress">Address</label> <asp:TextBox ID="txtOwnerAddress" runat="server" CssClass="form-control" TextMode="MultiLine" /> </div> </div> <div class="col-md-6"> <!-- Emergency Contact --> <h4>Emergency Contact</h4> <div class="form-group"> <label for="emergencyFullName">Full Name</label> <asp:TextBox ID="txtEmergencyFullName" runat="server" CssClass="form-control" /> </div> <div class="form-group"> <label for="emergencyMobile">Mobile</label> <asp:TextBox ID="txtEmergencyMobile" runat="server" CssClass="form-control" /> </div> <div class="form-group"> <label for="emergencyAddress">Address</label> <asp:TextBox ID="txtEmergencyAddress" runat="server" CssClass="form-control" TextMode="MultiLine" /> </div> </div> <div class="form-check"> <asp:CheckBox ID="chkSameAsOwner" runat="server" AutoPostBack="true" CssClass="form-check-input" /> <label class="form-check-label" for="sameAsOwner">Same as Owner Information</label> </div> </div> <!-- Condition of Animal --> <h4 class="text-center">Condition on Arrival</h4> <div class="form-group border p-3"> <div class="form-check"> <asp:RadioButton ID="rbActive" runat="server" CssClass="form-check-input" GroupName="mood" Value="active" /> <label class="form-check-label" for="active">Active</label> </div> <div class="form-check"> <asp:RadioButton ID="rbDull" runat="server" CssClass="form-check-input" GroupName="mood" Value="dull" /> <label class="form-check-label" for="dull">Dull</label> </div> <div class="form-check"> <asp:RadioButton ID="rbDepressed" runat="server" CssClass="form-check-input" GroupName="mood" Value="depressed" /> <label class="form-check-label" for="depressed">Depressed</label> </div> <div class="form-check"> <asp:RadioButton ID="rbOther" runat="server" CssClass="form-check-input" GroupName="mood" Value="other" /> <label class="form-check-label" for="other">Other (Write in Please specify)</label> <asp:TextBox class="form-control" ID="otherText" placeholder="Please specify" runat="server"></asp:TextBox> <asp:Label ID="label1" runat="server" Visible="false"></asp:Label> </div> <div> <div class="form-row"> <div class="col-md-6"> <!-- Body Temperature --> <div class="form-group"> <label for="bodyTemperature">Body Temperature</label> <asp:TextBox ID="txtBodyTemperature" runat="server" CssClass="form-control" /> </div> </div> <div class="col-md-6"> <!-- Rectal Palpation --> <div class="form-group"> <label for="rectalPalpation">Rectal Palpation</label> <asp:TextBox ID="txtRectalPalpation" runat="server" CssClass="form-control" /> </div> </div> </div> </div> </div> <div class="form-row"> <div class="col-md-6"> <!-- Rectal Palpation --> <div class="form-check"> <asp:CheckBox ID="check1" runat="server" CssClass="form-check-input" Text="Admitted" Checked="true" /> </div> </div> </div> <br /> <br /> <!-- Case History --> <div class="form-group"> <label for="caseHistory">Case History</label> <asp:TextBox ID="txtCaseHistory" runat="server" CssClass="form-control" TextMode="MultiLine" /> <asp:RequiredFieldValidator ID="RequiredFieldValidator17" runat="server" SetFocusOnError="true" ControlToValidate="txtCaseHistory" ValidationGroup="purchase" ErrorMessage="Please enter Case History" ForeColor="#ff0000"></asp:RequiredFieldValidator> </div> <!-- Submit Button --> <div class="text-center"> <asp:Button ID="button1" runat="server" Text="Register" CssClass="btn btn-primary mb-4" OnClick="button1_Click" ValidationGroup="purchase" /> </div> </div> </div> </form> </asp:Content>
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