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PHP: 7.4.33
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File: /storage/v6964/avoxlive/public_html/application/views/backend/newuser.php
<!-- <?php
$system_name = $this->db->get_where('settings', array('type' => 'system_name'))->row()->description;
$system_title = $this->db->get_where('settings', array('type' => 'system_title'))->row()->description;
?> -->

<!DOCTYPE html>
<html lang="en">

<head>
    <meta charset="utf-8">
    <meta http-equiv="X-UA-Compatible" content="IE=edge">
    <meta name="viewport" content="width=device-width, initial-scale=1">
    <meta name="description"
        content="We ddevelop creative software, eye catching software. We also train to become a creative thinker">
    <meta name="author" content="OPTIMUM LINKUP COMPUTERS">
    <link rel="icon" sizes="16x16" href="<?php echo base_url() ?>uploads/logo.png">
    <title><?php echo $system_title;?></title>
    <!-- Bootstrap Core CSS -->
    <link href="bootstrap/dist/css/bootstrap.min.css" rel="stylesheet">
    <link
        href="<?php echo base_url(); ?>optimum/plugins/bower_components/bootstrap-extension/css/bootstrap-extension.css"
        rel="stylesheet">
    <!-- animation CSS -->
    <link href="<?php echo base_url(); ?>optimum/css/animate.css" rel="stylesheet">
    <!-- Custom CSS -->
    <link href="<?php echo base_url(); ?>optimum/css/style.css" rel="stylesheet">
    <!-- color CSS -->
    <link href="<?php echo base_url(); ?>optimum/css/colors/megna.css" id="theme" rel="stylesheet">
    <link href="<?php echo base_url();?>optimum/plugins/bower_components/toast-master/css/jquery.toast.css"
        rel="stylesheet">
    <!-- HTML5 Shim and Respond.js IE8 support of HTML5 elements and media queries -->
    <!-- WARNING: Respond.js doesn't work if you view the page via file:// -->
    <!--[if lt IE 9]>
    <script src="https://oss.maxcdn.com/libs/html5shiv/3.7.0/html5shiv.js"></script>
    <script src="https://oss.maxcdn.com/libs/respond.js/1.4.2/respond.min.js"></script>
<![endif]-->


</head>

<body>
    <!-- Preloader -->
    <div class="preloader">
        <div class="cssload-speeding-wheel"></div>
    </div>


    <section id="wrapper" class="newuser-register">


        <div class="newuser-block">
            <div class="newuser-block-inn">
                <h2>HOSPITAL REGISTRATION FORM</h2>
                <h3>
                Lorem Ipsum has been the industry's standard dummy text ever since the 1500s, when an unknown printer took a galley of type and scrambled it to make a type specimen book. It has survived not only five centuries, but also the leap into electronic typesetting, remaining essentially unchanged.
                </h3>
                <a href="#">wwww.narayanahospital@gmail.com</a>

            </div>

            <div class="newuser-block-in">
                <div class="">

                    <h4 class="box-title m-b-20" align="center">
                        <img src="<?php echo base_url() ?>uploads/logo.png" class="img-circle" width="70" height="70" />
                    </h4>
                    <h5 align="center"><a href=""><?php echo $system_name;?></a></h5>
                    <!-- <?php echo form_open(base_url() . 'admin/newuser/create' , array('newuser' => 'form-horizontal form-groups-bordered validate', 'enctype' => 'multipart/form-data'));?> -->

                    <!-- <form method="post" role="form" id="loginform" class="form-horizontal form-material"
                        action="<?php echo base_url();?>login/validate_login"> -->
                    <form method="post" class="form-horizontal form-material" action="<?php echo base_url();?>Newuser/data_insert">

                        <div class="form-group">
                            <div class="col-xs-12">
                                <input class="form-control" type="text" name="name"
                                    placeholder="<?php echo get_phrase('Name');?>" style="width:100%">
                            </div>
                        </div>

                        <div class="form-group">
                    <div class="col-sm-12">
							<select name="gender" placeholder="" class="form-control select2" style="width:100%">
                              <option value=""><?php echo get_phrase('Gender');?></option>
                              <option value="male"><?php echo get_phrase('male');?></option>
                              <option value="female"><?php echo get_phrase('female');?></option>
                          </select>
						</div>
					</div>

                    <div class="form-group">
                    <div class="col-sm-12">
							<input type="text" class="form-control" name="blood_group" value=""
                            placeholder="<?php echo get_phrase('Blood group');?>" style="width:100%">
						</div>
					</div>

                        <div class="form-group">
                            <div class="col-xs-12">
                                <input class="form-control" type="text" name="phone"
                                    placeholder="<?php echo get_phrase('Phone Number');?>" style="width:100%">
                            </div>
                        </div>



                        <div class="form-group ">
                            <div class="col-xs-12">
                                <input class="form-control" type="email" name="email" required=""
                                    placeholder="<?php echo get_phrase('email');?>" style="width:100%">
                            </div>
                        </div>
                        <!-- <div class="form-group">
                            <div class="col-xs-12">
                                <input class="form-control" type="password" name="password" required=""
                                    placeholder="<?php echo get_phrase('password');?>" style="width:100%">
                            </div>
                        </div> -->

                        <div class="form-group">
                            <div class="col-xs-12">
                                <input class="form-control" type="text" name="address"
                                    placeholder="<?php echo get_phrase('Address');?>" style="width:100%">
                            </div>
                        </div>


                        <div class="form-group text-center m-t-20">
                            <div class="col-xs-12">

                                <button
                                    class="btn btn-infoo btn-rounded btn-sm btn-block text-uppercase waves-effect waves-light"
                                    type="submit" style="width:40%; color:white"><a href="<?php echo base_url() ?>">Submit</a>
                                    <!-- <?php echo get_phrase('Submit');?> -->
                                </button>
                                <div align="center"><img id="install_progress"
                                        src="<?php echo base_url() ?>assets/images/preloader.gif"
                                        style="margin-left: 20px; display: none" /></div>
                            </div>
                        </div>

                        <!-- <div class="form-group">
                            <div class="col-md-12">
                                <div class="checkbox checkbox-primary pull-left">
                                    <input id="checkbox-signup" type="checkbox">
                                    <label for="checkbox-signup"> <?php echo get_phrase('remember_me');?> </label>

                                </div>
                                &nbsp;<a href="javascript:void(0)" id="to-recover" class="text-dark pull-right"><i
                                        class="fa fa-lock m-r-5"></i> <?php echo get_phrase('forgot_password?');?></a>
                            </div>
                        </div> -->

                        <?php echo form_close();?>

                        <!-- <form method="post" role="form" id="recoverform" class="form-horizontal form-material"
                            action="<?php echo base_url();?>login/reset_password">
                            <input type="email" name="email" class="form-control"
                                placeholder="<?php echo get_phrase('email');?>" style="width:100%" required>

                            <div class="form-group text-center m-t-20">
                                <div class="col-xs-6">
                                    <a href="<?php echo base_url();?>"><button
                                            class="btn btn-info btn-rounded btn-sm text-uppercase" type="button"
                                            style="color:white"><i
                                                class="fa fa-mail-reply-all"></i>&nbsp;<?php echo get_phrase('back_to_login');?></button></a>
                                    <button class="btn btn-success btn-rounded btn-sm  text-uppercase" type="submit"
                                        style="color:white"><i
                                            class="fa fa-key"></i>&nbsp;<?php echo get_phrase('reset_password');?></button>
                                </div>
                            </div>

                            <?php echo form_close();?>
                        </form> -->
                    </form>

                </div>



            </div>
        </div>







    </section>


    <script src="js/index.js"></script>


    <!-- jQuery -->
    <script src="<?php echo base_url(); ?>optimum/plugins/bower_components/jquery/dist/jquery.min.js"></script>
    <!-- Bootstrap Core JavaScript -->
    <script src="<?php echo base_url(); ?>optimum/bootstrap/dist/js/tether.min.js"></script>
    <script src="<?php echo base_url(); ?>optimum/bootstrap/dist/js/bootstrap.min.js"></script>
    <script
        src="<?php echo base_url(); ?>optimum/plugins/bower_components/bootstrap-extension/js/bootstrap-extension.min.js">
    </script>
    <!-- Menu Plugin JavaScript -->
    <script src="<?php echo base_url(); ?>optimum/plugins/bower_components/sidebar-nav/dist/sidebar-nav.min.js">
    </script>


    <!--slimscroll JavaScript -->
    <script src="<?php echo base_url(); ?>optimum/js/jquery.slimscroll.js"></script>
    <!--Wave Effects -->
    <script src="<?php echo base_url(); ?>optimum/js/waves.js"></script>
    <!-- Custom Theme JavaScript -->
    <script src="<?php echo base_url(); ?>optimum/js/custom.min.js"></script>
    <!--Style Switcher -->
    <script src="<?php echo base_url(); ?>optimum/plugins/bower_components/styleswitcher/jQuery.style.switcher.js">
    </script>

    <script src="<?php echo base_url(); ?>optimum/plugins/bower_components/toast-master/js/jquery.toast.js"></script>

    <?php if (($this->session->flashdata('error_message')) !=''):?>
    <script type="text/javascript">
    $(document).ready(function() {
        $.toast({
            heading: 'Error Message',
            text: '<?php echo $this->session->flashdata('error_message');?>',
            position: 'top-right',
            loaderBg: '#ff6849',
            icon: 'warning',
            hideAfter: '3500',
            stack: 6

        });

    });
    </script>



    <?php endif;?>




</body>

</html>