This commit is contained in:
Olusesan Ameye
2021-02-18 12:49:34 -05:00
parent 1ef0c97147
commit a045bbce5a
@@ -0,0 +1,52 @@
<?
$read_level = " readonly "
?>
<div class="card card-statistics">
<div class="card-header">
<div class="card-heading">
<h4 class="card-title">Practice Name :<span style="color:green;"> <?=$name?></span> </h4>
</div>
</div>
<div class="card-body">
<form id="signupForm" method="post" class="form-horizontal">
<div class="form-group">
<label class="control-label" for="fname">First name</label>
<div class="mb-2">
<input type="text" class="form-control" id="fname" name="firstname" value="<?=$lastname?>" placeholder="First name" />
</div>
</div>
<div class="form-group">
<label class="control-label" for="lname">Last name</label>
<div class="mb-2">
<input type="text" class="form-control" id="lname" name="lastname" value="<?=$lastname?>" placeholder="Last name" />
</div>
</div>
<div class="form-group">
<label class="control-label" for="uname">Username</label>
<div class="mb-2">
<input type="text" class="form-control" id="uname" name="username" value="<?=$username?>" <?=$read_level?> placeholder="Username" />
</div>
</div>
<div class="form-group">
<label class="control-label" for="uemail">Email</label>
<div class="mb-2">
<input type="text" class="form-control" id="uemail" name="email" value="<?=$email?>" <?=$read_level?> placeholder="Email" />
</div>
</div>
<div class="form-group">
<label class="control-label" for="upassword">Date Added</label>
<div class="mb-2">
<input type="text" class="form-control" id="upassword" name="added" value="<?=$added?>" <?=$read_level?> placeholder="added" />
</div>
</div>
<div class="form-group">
<button type="submit" class="btn btn-secondary" name="signup" value="Sign up">Update</button>
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
<button type="submit" class="btn btn-primary" name="signup" value="Sign up">Manage</button>
</div>
</form>
</div>
</div>