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HTML 

              
                 <div class="container">
        <h1>Cardiology Intake Form</h1>
        <div class="progress-bar">
            <div class="progress"></div>
        </div>
        <form id="cardiologyForm">
            <!-- Personal Information -->
            <div class="form-section active" data-section="1">
                <h2 class="section-title">Personal Information</h2>
                <div class="form-group">
                    <label for="fullName">Full Name</label>
                    <input type="text" id="fullName" required>
                </div>
                <div class="form-group">
                    <label for="dob">Date of Birth</label>
                    <input type="date" id="dob" required>
                </div>
                <div class="form-group">
                    <label for="phone">Phone Number</label>
                    <input type="tel" id="phone" required>
                </div>
                <div class="form-group">
                    <label for="email">Email</label>
                    <input type="email" id="email" required>
                </div>
            </div>

            <!-- Insurance Details -->
            <div class="form-section" data-section="2">
                <h2 class="section-title">Insurance Details</h2>
                <div class="form-group">
                    <label for="provider">Insurance Provider</label>
                    <input type="text" id="provider" required>
                </div>
                <div class="form-group">
                    <label for="policyNumber">Policy Number</label>
                    <input type="text" id="policyNumber" required>
                </div>
            </div>

            <!-- Medical History -->
            <div class="form-section" data-section="3">
                <h2 class="section-title">Medical History</h2>
                <div class="form-group">
                    <label>Known Medical Conditions</label>
                    <div class="checkbox-group">
                        <div class="checkbox-item">
                            <input type="checkbox" id="hypertension">
                            <label for="hypertension">Hypertension</label>
                        </div>
                        <div class="checkbox-item">
                            <input type="checkbox" id="diabetes">
                            <label for="diabetes">Diabetes</label>
                        </div>
                        <div class="checkbox-item">
                            <input type="checkbox" id="cholesterol">
                            <label for="cholesterol">High Cholesterol</label>
                        </div>
                    </div>
                </div>
                <div class="form-group">
                    <label for="familyHistory">Family History of Heart Disease</label>
                    <select id="familyHistory" required>
                        <option value="">Select...</option>
                        <option value="yes">Yes</option>
                        <option value="no">No</option>
                    </select>
                </div>
                <div class="form-group">
                    <label for="medications">Current Medications</label>
                    <textarea id="medications" rows="3"></textarea>
                </div>
            </div>

            <!-- Heart-Related Symptoms -->
            <div class="form-section" data-section="4">
                <h2 class="section-title">Heart-Related Symptoms</h2>
                <div class="form-group">
                    <label>Current Symptoms</label>
                    <div class="checkbox-group">
                        <div class="checkbox-item">
                            <input type="checkbox" id="chestPain">
                            <label for="chestPain">Chest Pain</label>
                        </div>
                        <div class="checkbox-item">
                            <input type="checkbox" id="shortnessBreath">
                            <label for="shortnessBreath">Shortness of Breath</label>
                        </div>
                        <div class="checkbox-item">
                            <input type="checkbox" id="irregularHeartbeat">
                            <label for="irregularHeartbeat">Irregular Heartbeat</label>
                        </div>
                    </div>
                </div>
                <div class="form-group">
                    <label for="otherSymptoms">Other Symptoms</label>
                    <textarea id="otherSymptoms" rows="3"></textarea>
                </div>
            </div>

            <!-- Lifestyle Factors -->
            <div class="form-section" data-section="5">
                <h2 class="section-title">Lifestyle Factors</h2>
                <div class="form-group">
                    <label for="smokingStatus">Smoking Status</label>
                    <select id="smokingStatus" required>
                        <option value="">Select...</option>
                        <option value="current">Current Smoker</option>
                        <option value="former">Former Smoker</option>
                        <option value="never">Never Smoked</option>
                    </select>
                </div>
                <div class="form-group">
                    <label for="alcohol">Alcohol Consumption</label>
                    <select id="alcohol" required>
                        <option value="">Select...</option>
                        <option value="yes">Yes</option>
                        <option value="no">No</option>
                    </select>
                </div>
            </div>

            <!-- Previous Cardiac Tests -->
            <div class="form-section" data-section="6">
                <h2 class="section-title">Previous Cardiac Tests or Procedures</h2>
                <div class="form-group">
                    <label>Previous Tests</label>
                    <div class="checkbox-group">
                        <div class="checkbox-item">
                            <input type="checkbox" id="ekg">
                            <label for="ekg">EKG</label>
                        </div>
                        <div class="checkbox-item">
                            <input type="checkbox" id="stressTest">
                            <label for="stressTest">Stress Test</label>
                        </div>
                        <div class="checkbox-item">
                            <input type="checkbox" id="echocardiogram">
                            <label for="echocardiogram">Echocardiogram</label>
                        </div>
                    </div>
                </div>
                <div class="form-group">
                    <label for="surgeries">Previous Surgeries or Interventions</label>
                    <select id="surgeries" required>
                        <option value="">Select...</option>
                        <option value="yes">Yes</option>
                        <option value="no">No</option>
                    </select>
                </div>
            </div>

            <div class="buttons">
                <button type="button" class="btn-prev" id="prevBtn" style="display: none;">Previous</button>
                <button type="button" class="btn-next" id="nextBtn">Next</button>
                <button type="submit" class="btn-submit" id="submitBtn" style="display: none;">Submit</button>
            </div>
        </form>
    </div>
!

CSS 

              
                :root {
            --primary: #647dee;
            --secondary: #7f53ac;
            --background: #f8f9fa;
            --text: #2d3436;
            --error: #ff7675;
            --success: #55efc4;
        }

        * {
            margin: 0;
            padding: 0;
            box-sizing: border-box;
            font-family: 'Segoe UI', Tahoma, Geneva, Verdana, sans-serif;
        }

        body {
            background: var(--background);
            color: var(--text);
            line-height: 1.6;
            padding: 2rem;
        }

        .container {
            max-width: 800px;
            margin: 0 auto;
            background: white;
            padding: 2rem;
            border-radius: 15px;
            box-shadow: 0 10px 20px rgba(0,0,0,0.1);
        }

        h1 {
            text-align: center;
            color: var(--primary);
            margin-bottom: 2rem;
            font-size: 2.5rem;
        }

        .progress-bar {
            width: 100%;
            height: 5px;
            background: #eee;
            margin-bottom: 2rem;
            border-radius: 10px;
            overflow: hidden;
        }

        .progress {
            width: 0%;
            height: 100%;
            background: linear-gradient(to right, var(--primary), var(--secondary));
            transition: width 0.3s ease;
        }

        .form-section {
            display: none;
            animation: fadeIn 0.5s ease;
        }

        .form-section.active {
            display: block;
        }

        .section-title {
            color: var(--primary);
            margin: 1.5rem 0;
            padding-bottom: 0.5rem;
            border-bottom: 2px solid var(--primary);
        }

        .form-group {
            margin-bottom: 1.5rem;
        }

        label {
            display: block;
            margin-bottom: 0.5rem;
            font-weight: 500;
        }

        input[type="text"],
        input[type="email"],
        input[type="tel"],
        input[type="date"],
        textarea,
        select {
            width: 100%;
            padding: 0.8rem;
            border: 1px solid #ddd;
            border-radius: 8px;
            font-size: 1rem;
            transition: border-color 0.3s ease;
        }

        input:focus,
        textarea:focus,
        select:focus {
            outline: none;
            border-color: var(--primary);
        }

        .checkbox-group {
            display: grid;
            grid-template-columns: repeat(auto-fit, minmax(200px, 1fr));
            gap: 1rem;
        }

        .checkbox-item {
            display: flex;
            align-items: center;
            gap: 0.5rem;
        }

        .buttons {
            display: flex;
            justify-content: space-between;
            margin-top: 2rem;
        }

        button {
            padding: 0.8rem 2rem;
            border: none;
            border-radius: 8px;
            font-size: 1rem;
            cursor: pointer;
            transition: transform 0.2s ease, background 0.3s ease;
        }

        button:hover {
            transform: translateY(-2px);
        }

        .btn-prev {
            background: #eee;
            color: var(--text);
        }

        .btn-next {
            background: var(--primary);
            color: white;
        }

        .btn-submit {
            background: var(--success);
            color: white;
        }

        @keyframes fadeIn {
            from { opacity: 0; transform: translateY(20px); }
            to { opacity: 1; transform: translateY(0); }
        }

        @media (max-width: 600px) {
            body {
                padding: 1rem;
            }
            
            .container {
                padding: 1rem;
            }

            .checkbox-group {
                grid-template-columns: 1fr;
            }
        }
!

JS 

              
                 document.addEventListener('DOMContentLoaded', function() {
            const form = document.getElementById('cardiologyForm');
            const sections = document.querySelectorAll('.form-section');
            const progressBar = document.querySelector('.progress');
            const prevBtn = document.getElementById('prevBtn');
            const nextBtn = document.getElementById('nextBtn');
            const submitBtn = document.getElementById('submitBtn');
            let currentSection = 0;

            function updateButtons() {
                prevBtn.style.display = currentSection === 0 ? 'none' : 'block';
                if (currentSection === sections.length - 1) {
                    nextBtn.style.display = 'none';
                    submitBtn.style.display = 'block';
                } else {
                    nextBtn.style.display = 'block';
                    submitBtn.style.display = 'none';
                }
            }

            function updateProgress() {
                const progress = ((currentSection + 1) / sections.length) * 100;
                progressBar.style.width = `${progress}%`;
            }

            function showSection(sectionIndex) {
                sections.forEach((section, index) => {
                    section.classList.toggle('active', index === sectionIndex);
                });
                updateButtons();
                updateProgress();
            }

            prevBtn.addEventListener('click', () => {
                if (currentSection > 0) {
                    currentSection--;
                    showSection(currentSection);
                }
            });

            nextBtn.addEventListener('click', () => {
                if (currentSection < sections.length - 1) {
                    currentSection++;
                    showSection(currentSection);
                }
            });

            form.addEventListener('submit', (e) => {
                e.preventDefault();
                // Add your form submission logic here
                alert('Form submitted successfully!');
            });

            // Initialize
            updateButtons();
            updateProgress();
        });
!
999px

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