<!DOCTYPE html>
<html lang="en">
<head>
<meta charset="UTF-8">
<meta name="viewport" content="width=device-width, initial-scale=1.0">
<title>MBBS Enquiry Form</title>
<style>
body {
font-family: Arial, sans-serif;
background-color: #f7f7f7;
margin: 0;
padding: 0;
}
.container {
width: 50%;
margin: 0 auto;
background-color: #fff;
padding: 20px;
box-shadow: 0 0 10px rgba(0, 0, 0, 0.1);
margin-top: 50px;
}
h2 {
text-align: center;
}
.form-group {
margin-bottom: 15px;
}
.form-group label {
display: block;
margin-bottom: 5px;
}
.form-group input, .form-group select, .form-group textarea {
width: 100%;
padding: 10px;
border: 1px solid #ccc;
border-radius: 5px;
}
.form-group input[type="radio"] {
width: auto;
}
.form-group input[type="submit"] {
background-color: #28a745;
color: #fff;
border: none;
cursor: pointer;
padding: 15px;
}
.form-group input[type="submit"]:hover {
background-color: #218838;
}
</style>
</head>
<body>
<div class="container">
<h2>MBBS Enquiry Form</h2>
<form action="submit_form.php" method="post">
<div class="form-group">
<label for="student_name">Student's Name</label>
<input type="text" id="student_name" name="student_name" required>
</div>
<div class="form-group">
<label for="father_name">Father's Name</label>
<input type="text" id="father_name" name="father_name" required>
</div>
<div class="form-group">
<label for="gender">Gender</label>
<input type="radio" id="male" name="gender" value="male" required> Male
<input type="radio" id="female" name="gender" value="female" required> Female
<input type="radio" id="other" name="gender" value="other" required> Other
</div>
<div class="form-group">
<label for="contact_number">Contact Number</label>
<input type="text" id="contact_number" name="contact_number" required>
</div>
<div class="form-group">
<label for="whatsapp_number">WhatsApp Number</label>
<input type="text" id="whatsapp_number" name="whatsapp_number">
</div>
<div class="form-group">
<label for="category">Category</label>
<select id="category" name="category" required>
<option value="general">General</option>
<option value="obc">OBC</option>
<option value="sc">SC</option>
<option value="st">ST</option>
</select>
</div>
<div class="form-group">
<label for="neet_score">NEET Score</label>
<input type="text" id="neet_score" name="neet_score" required>
</div>
<div class="form-group">
<label for="city">City</label>
<input type="text" id="city" name="city" required>
</div>
<div class="form-group">
<label for="home_state">Home State</label>
<input type="text" id="home_state" name="home_state" required>
</div>
<div class="form-group">
<label for="courses">Interested Courses</label>
<input type="text" id="courses" name="courses" required>
</div>
<div class="form-group">
<label for="budget">Budget for Colleges</label>
<input type="text" id="budget" name="budget" required>
</div>
<div class="form-group">
<label for="queries">Additional Queries</label>
<textarea id="queries" name="queries"></textarea>
</div>
<div class="form-group">
<input type="submit" value="Submit">
</div>
</form>
</div>
</body>
</html>