fuyu
/
tjshop


			
				
					
						
						
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							<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Transitional//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-transitional.dtd">
<html xmlns="http://www.w3.org/1999/xhtml">
<head>
<meta http-equiv="Content-Type" content="text/html; charset=utf-8" />
<title>预约体检</title>
<meta name="viewport" content="width=device-width, initial-scale=1.0, user-scalable=no"/>
<link href="style/style.css" rel="stylesheet" />
</head>

<body>
	<dl class="registerBar">
    	<img src="style/Register_bar2.png" />
    	<dt>套餐详情</dt>
        <dt>体检信息</dt>
        <dd>完成预约</dd>
    </dl>
    <div class="registerPost">
    	<form>
            <h6>选择体检人:</h6>
            <table><tr><td>
                <input name="creat" type="radio" value="" id="tj0" class="radio" checked="checked" /><label for="tj0">新建体检人</label>
                <input name="creat" type="radio" value="" id="tj1" class="radio" /><label for="tj1">王美丽</label>
			</td></tr></table>
            <h6>体检人证件号:</h6>
            <table><tr>
            	<td style="width:100px; "><div class="box mr10"><select name=""><option>身份证</option><option>护照号</option></select></div></td>
                <td><div class="box"><input name="" type="text" /></div></td>
			</tr></table>
            <h6>姓名:</h6>
            <table><tr><td>
                <div class="box"><input name="" type="text" /></div>
            </td></tr></table>
            <h6>性别:</h6>
            <table><tr><td>
                <input name="sex" type="radio" class="radio" id="n" value="" checked="checked" /><label for="n">男</label>
                <input name="sex" type="radio" value="" id="v" class="radio" /><label for="v">女</label>
            </td></tr></table>
            <h6>手机号码:</h6>
            <table><tr><td>
				<div class="box"><input name="" type="tel" /></div>
            </td></tr></table>
            <h6>体检日期及时间:</h6>
            <table>
            	<tr><td><div class="box"><input name="" type="date" /></div></td></tr>
                <tr><td><div class="box mt10"><select name=""><option></option><option>8:00</option><option>8:30</option></select></div></td></tr>
            </table>
            <div class="h100"></div>
			<div class="registerBottom"><a href="###" class="last">上一步</a><a href="###" class="next">下一步</a></div>
		</form>
	</div>
    
    
	<!--<div class="v-form">
    	<dl><dt>体检人</dt><dd><div><input name="" type="text" class="txt" /></div></dd></dl>
        <dl><dt>性别</dt><dd><div><input name="" type="radio" value="" /><label>男</label><input name="" type="radio" value="" /><label>女</label></div></dd></dl>
        <dl><dt>身份证号</dt><dd><div><input name="" type="text" class="txt" /></div></dd></dl>
        <dl><dt>手机号</dt><dd><div><input name="" type="text" class="txt" /></div></dd></dl>
        <dl><dt>体检时间</dt><dd><div><input name="" type="date" class="txt" /></div></dd></dl>
    </div>-->
</body>
</html>