<?php
include('../baglan.php');
include('../css.php');



?>

<form name="form1" method="post" action="admin.php?target=epilasyonkartiekle-islem">
<div class="nav-tabs-custom">
                                <ul class="nav nav-tabs">
                                    <li class="active">
										 <a href="#tab_1" data-toggle="tab">Lazer Epilasyon Kart Bilgileri</a></li>
                                    
                                    <li class="pull-right"><a href="#" class="text-muted"><i class="fa fa-gear"></i></a></li>
                                </ul>
                                <div class="tab-content" >

 <div class="tab-pane active" id="tab_1">



<div class="box box-success">
                <div class="box-header with-border">
                  <h3 class="box-title">Lazer Epilasyon Kart Bilgileri</h3>
                </div>


 <div class="box-body">
<input name="LAZER_ID" type="hidden" id="LAZER_ID" size="20" />


<input  name="LAZER_TARIH" id="LAZER_TARIH" class="form-control" type="text" placeholder="Görüş Tarihi" value="<?php echo date('d.m.Y '); ?>"  ><br>


<input name="LAZER_ADI_SOYADI" id="LAZER_ADI_SOYADI" class="form-control" type="text" placeholder="Adı Soyadı" ><br>
<input name="LAZER_DOGUM_TARIHI" id="LAZER_DOGUM_TARIHI" class="form-control" type="text" placeholder="Doğum Tarihi"><br>
<textarea name="LAZER_ADRES" id="LAZER_ADRES" class="form-control" rows="3" placeholder="Adres ..."></textarea><br>

<input name="LAZER_TELEFON" id="LAZER_TELEFON" class="form-control" type="text" placeholder="Telefon Numarası" ><br>

<input name="LAZER_MAIL" id="LAZER_MAIL" class="form-control" type="text" placeholder="Mail Adresi" ><br>







                  
                </div><!-- /.box-body -->
              </div><!-- /.box -->



</div>

  






                                </div><!-- /.tab-content -->
<input name="button" type="submit"  class="btn btn-block btn-success" id="button" value="Lazer Epilasyon Kartı  Ekle" />
 
                            </div><!-- nav-tabs-custom -->
                        </div>

</form>

