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<!-- PatientInfoForm.php -->
<?php session_start();
$user = $_POST['user'];
$pass = $_POST['pass'];
$_SESSION['usr'] = $user;
$_SESSION['psw'] = $pass;
if($user != "cs480" || $pass != "hw10")
print "go away.";
else
{
?>
<CENTER>
<H2>
Patient Info System
</H2>
<HR>
<FONT color=blue size=4>
<FORM action=PatientInfoSelect.php method=post>
Your name? <INPUT type=text name=name>
<P>
Your contact phone? <INPUT type=text name=phone>
<P>
Your gender?
<INPUT type=radio name=q1 value=m checked> Male
<INPUT type=radio name=q1 value=f> Female
<P>
</FONT>
<INPUT type=submit value="Submit Form">
<INPUT type=reset value="Reset Form">
</FORM>
</CENTER>
<?php
}
?>