Registration Form php pazienti by @garghy64 - Codewith.it

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<blockquote>Inserisce citazioni in un documento HTML
<table>Tag primario per la creazione di tabelle
headersDetermina la relazione tra celle e celle di intestazione di una tabella.
<select>Usato per creare un menu a tendina.
<html>Tag primario di un documento HTML
<em>Formatta il testo in corsivo/italico enfatizzato

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<!DOCTYPE html>
<html lang="en">
  <head>
    <meta charset="UTF-8">
    <meta name="viewport" content="width=device-width, initial-scale=1.0">
    <title>Registration Form</title>
  </head>
  <body>

    

    <h1>Register</h1>
    <form>
        <label for="surname">Surname:</label>
        <input type="text" id="surname" name="surname" required>

        <label for="name">Name:</label>
        <input type="text" id="name" name="name" required>

        <label for="birth">Birth:</label>
        <input type="date" id="birth" name="birth" required>

        <label for="province">Province:</label>
        <input type="text" id="province" name="province" required>

        <label for="codASL">Cod ASL:</label>
        <input type="text" id="codASL" name="codASL" required>

        <button type="submit">Register</button>
    </form>
  </body>
</html>

body {
  font-family: Arial, sans-serif;
  margin: 20px;
  color: #313131;
}

h1 {
  color: #6924e7;
}

form {
  max-width: 400px;
  margin: auto;
  padding: 20px;
  border: 1px solid #ccc;
  border-radius: 5px;
  background-color: #f9f9f9;
}

label {
  display: block;
  margin-bottom: 8px;
}

input,
select {
  width: 100%;
  padding: 10px;
  margin-bottom: 10px;
  border: 1px solid #ccc;
  border-radius: 5px;
}

button {
  background-color: #007BFF;
  color: white;
  border: none;
  padding: 10px 15px;
  border-radius: 5px;
  cursor: pointer;
}

button:hover {
  background-color: #0056b3;
}

<?php
        $surnameErr = $nameErr = $birthErr = $provinceErr = $codASLErr = "";
$surname = $name = $birth = $province = $codASL = "";

if ($_SERVER["REQUEST_METHOD"] == "POST") {
  if (empty($_POST["name"])) {
    $nameErr = "Name is required";
  } else {
    $name = test_input($_POST["name"]);
    if (!preg_match("/^[a-zA-Z-' ]*$/",$name)) {
      $nameErr = "Only letters and white space allowed";
    }
  }

  if (empty($_POST["surname"])) {
    $surnameErr = "Surname is required";
  } else {
    $surname = test_input($_POST["surname"]);
    if (!preg_match("/^[a-zA-Z-' ]*$/",$surname)) {
      $surnameErr = "Only letters and white space allowed";
    }
  }
  
  if (empty($_POST["birth"])) {
    $birthErr = "Birth is required";
  } else {
    $birth = test_input($_POST["birth"]);
    
    if (!filter_var($birth, FILTER_VALIDATE_BIRTH)) {
      $birthErr = "Invalid birth format";
    }
  }

  if (empty($_POST["province"])) {
    $province = "";
  } else {
    $province = test_input($_POST["province"]);
  }
  
}

function test_input($data) {
  $data = trim($data);
  $data = stripslashes($data);
  $data = htmlspecialchars($data);
  return $data;
}
?>