{% extends "base.html" %} {% block title %}Register - Quick Care Connect{% endblock %} {% block extra_css %} {% endblock %} {% block content %}

Create Your Account

Join Quick Care Connect carefully.

{{ form.hidden_tag() }}
Select Your Role
{{ form.role.label(class="form-label") }} {% if form.role.errors %}
{% for error in form.role.errors %}{{ error }}{% endfor %}
{% endif %}

Personal Information

{{ form.name.label(class="form-label") }} {{ form.name(class="form-control", autocomplete="off", autofill="off") }} {% if form.name.errors %}
{% for error in form.name.errors %}{{ error }}{% endfor %}
{% endif %}
{{ form.email.label(class="form-label") }} {{ form.email(class="form-control", autocomplete="off", autofill="off", id="register-email") }} {% if form.email.errors %}
{% for error in form.email.errors %}{{ error }}{% endfor %}
{% endif %}
{{ form.phone.label(class="form-label") }}
+92 {{ form.phone(class="form-control", id="phone-input", autocomplete="off", autofill="off", placeholder="3001234567", maxlength="10") }}
{% if form.phone.errors %}
{% for error in form.phone.errors %}{{ error }}{% endfor %}
{% endif %}
{{ form.cnic.label(class="form-label") }} {{ form.cnic(class="form-control", autocomplete="off", autofill="off") }} {% if form.cnic.errors %}
{% for error in form.cnic.errors %}{{ error }}{% endfor %}
{% endif %} Enter 13-digit CNIC number (e.g., 1234512345671)
{{ form.date_of_birth.label(class="form-label") }}
{{ form.date_of_birth(class="form-control", id="date-of-birth-input", type="date", autocomplete="off", autofill="off") }}
{% if form.date_of_birth.errors %}
{% for error in form.date_of_birth.errors %}{{ error }}{% endfor %}
{% endif %} Click to select your date of birth
{{ form.gender.label(class="form-label") }} {{ form.gender(class="form-select", autocomplete="off", autofill="off") }} {% if form.gender.errors %}
{% for error in form.gender.errors %}{{ error }}{% endfor %}
{% endif %}
{{ form.profile_picture.label(class="form-label") }} {{ form.profile_picture(class="form-control", accept="image/jpeg,image/jpg,image/png") }} {% if form.profile_picture.errors %}
{% for error in form.profile_picture.errors %}{{ error }}{% endfor %}
{% endif %} Upload your profile picture (JPG, PNG - Optional)
{{ form.city.label(class="form-label") }}
{{ form.city(class="form-control", id="city-input", autocomplete="off", autofill="off") }}
{% if form.city.errors %}
{% for error in form.city.errors %}{{ error }}{% endfor %}
{% endif %}
{{ form.password.label(class="form-label") }}
{{ form.password(class="form-control password-field", id="password-input", autocomplete="new-password", autofill="off") }}
{% if form.password.errors %}
{% for error in form.password.errors %}{{ error }}{% endfor %}
{% endif %}
{{ form.password2.label(class="form-label") }}
{{ form.password2(class="form-control password-field", id="password2-input", autocomplete="new-password", autofill="off") }}
{% if form.password2.errors %}
{% for error in form.password2.errors %}{{ error }}{% endfor %}
{% endif %}

Please complete your profile after registration to access all features.

Professional Information

{{ form.specialization(class="form-control", id="specialization-input", autocomplete="off", autofill="off", required=True) }}
{% if form.specialization.errors %}
{% for error in form.specialization.errors %}{{ error }}{% endfor %}
{% endif %}
{{ form.experience.label(class="form-label") }} {{ form.experience(class="form-control") }} {% if form.experience.errors %}
{% for error in form.experience.errors %}{{ error }}{% endfor %}
{% endif %}
{{ form.pmc_code.label(class="form-label") }} {{ form.pmc_code(class="form-control") }} {% if form.pmc_code.errors %}
{% for error in form.pmc_code.errors %}{{ error }}{% endfor %}
{% endif %}
{{ form.qualifications.label(class="form-label") }} {% if form.qualifications.errors %}
{% for error in form.qualifications.errors %}{{ error }}{% endfor %}
{% endif %} Enter all your degrees, qualifications, and certifications
{{ form.bio.label(class="form-label") }} {{ form.bio(class="form-control", rows="3") }} {% if form.bio.errors %}
{% for error in form.bio.errors %}{{ error }}{% endfor %}
{% endif %}

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{% endblock %} {% block extra_js %} {% endblock %}