| 1 | <!DOCTYPE html>
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| 2 | <html lang="en" xmlns="http://www.w3.org/1999/xhtml" xmlns:th="http://www.thymeleaf.org">
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| 3 | <head>
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| 4 | <meta charset="UTF-8">
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| 5 | <link rel="shortcut icon" th:href="@{assets/images/favicon.ico}">
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| 6 | <link href="https://cdn.jsdelivr.net/npm/bootstrap@5.1.0/dist/css/bootstrap.min.css" rel="stylesheet" integrity="sha384-KyZXEAg3QhqLMpG8r+8fhAXLRk2vvoC2f3B09zVXn8CA5QIVfZOJ3BCsw2P0p/We" crossorigin="anonymous">
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| 7 | <script src="https://cdn.jsdelivr.net/npm/@popperjs/core@2.9.3/dist/umd/popper.min.js" integrity="sha384-eMNCOe7tC1doHpGoWe/6oMVemdAVTMs2xqW4mwXrXsW0L84Iytr2wi5v2QjrP/xp" crossorigin="anonymous"></script>
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| 8 | <script src="https://cdn.jsdelivr.net/npm/bootstrap@5.1.0/dist/js/bootstrap.min.js" integrity="sha384-cn7l7gDp0eyniUwwAZgrzD06kc/tftFf19TOAs2zVinnD/C7E91j9yyk5//jjpt/" crossorigin="anonymous"></script>
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| 9 | <link rel="stylesheet" href="https://cdnjs.cloudflare.com/ajax/libs/font-awesome/4.7.0/css/font-awesome.min.css">
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| 10 | <title> Регистрирај се </title>
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| 11 | </head>
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| 12 | <body>
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| 13 | <div class="container mt-5">
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| 14 | <h3 align="justify"> </h3>
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| 15 | <div class="card" style="width: 55rem; ">
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| 16 | <div class="card-header text-center bg-info ">
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| 17 | <h3> Регистрирај се </h3>
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| 18 | </div>
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| 19 | <div class="card-body">
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| 20 | <form th:action="@{/save}" method="post" th:object="${pacient}">
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| 21 | <div class="form-group">
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| 22 | <label for="ime"> Име </label>
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| 23 | <input type="text" class="form-control" id="ime" name="ime" aria-describedby="emailHelp" required th:field="*{ime}">
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| 24 | </div>
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| 25 | <div class="form-group">
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| 26 | <label for="prezime"> Презиме </label>
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| 27 | <input type="text" class="form-control" id="prezime" name="prezime" aria-describedby="emailHelp" required th:field="*{prezime}">
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| 28 | </div>
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| 29 | <div class="form-group">
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| 30 | <label for="embg"> ЕМБГ </label>
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| 31 | <input type="text" class="form-control" id="embg" name="embg" aria-describedby="emailHelp" required th:field="*{embg}">
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| 32 | </div>
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| 33 | <div class="form-group">
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| 34 | <label for="email"> Емаил </label>
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| 35 | <input type="email" class="form-control" id="email" name="email" aria-describedby="emailHelp" required th:field="*{email}">
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| 36 | </div>
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| 37 | <div class="form-group">
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| 38 | <label for="pass"> Лозинка </label>
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| 39 | <input type="password" class="form-control" id="pass" name="pass" required th:field="*{pass}">
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| 40 | </div>
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| 41 | <button type="submit" class="btn btn-primary"> Потврди </button>
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| 42 | </form>
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| 43 | <a href="/home" class="btn btn-block btn-light"> Назад кон почетна страна </a>
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| 44 | </div>
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| 45 | </div>
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| 46 | </div>
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| 47 | </body>
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| 48 | </html>
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