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form-reserva-hora-medica.html
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form-reserva-hora-medica.html
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<!DOCTYPE html>
<html lang="es-cl">
<head>
<meta charset="UTF-8" />
<meta name="viewport" content="width=device-width, initial-scale=1.0" />
<title>Clínica Valentine - Reserva tu hora</title>
</head>
<body>
<h1>Reserva tu hora</h1>
<form action="./received-page-reserva-hora-medica.html" method="get">
<fieldset>
<legend>Información personal</legend>
<label for="user-name">Nombre</label>
<br />
<input type="text" id="user-name" name="user-name" required />
<br />
<label for="user-address">Dirección</label>
<br />
<input type="text" id="user-address" name="user-address" required />
<br />
<label for="user-email">Correo</label>
<br />
<input type="email" id="user-email" name="user-email" required />
<br />
</fieldset>
<fieldset>
<legend>Información hora médica</legend>
<label for="especialidad-medica">Especialidad médica</label>
<br />
<select name="especialidad-medica" id="especialidad-medica" required>
<option value="" disabled selected>Seleccione una especialidad</option>
<option value="medicina-interna">Medicina Interna</option>
<option value="medicina-general">Medicina General</option>
<option value="traumatologia">Traumatología</option>
<option value="nutricionista">Nutricionaista</option>
</select>
<br />
<label for="fecha">Fecha</label>
<br />
<input type="date" name="fecha" id="fecha" required />
<br />
<label for="hora">Hora</label>
<br />
<input type="time" name="hora" id="hora" required />
<br />
</fieldset>
<button type="submit">Confirmar</button>
</form>
</body>
</html>