calebasse / calebasse / dossiers / templates / dossiers / patientaddress_form.html @ 26c60057
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{% load widget_tweaks %} |
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<form action="{{ request.get_full_path }}" method="post"> |
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{% csrf_token %} |
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<table>
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<tbody>
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<tr>
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<p>
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</p>
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<td>
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{{ form.number.label_tag }} :<br>
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{{ form.number }} |
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{{ form.number.errors }} |
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</td>
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<td>
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{{ form.street.label_tag }} :<br>
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{{ form.street }} |
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{{ form.street.errors }} |
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</td>
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</tr>
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<tr>
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<td></td>
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<td>
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{{ form.address_complement.label_tag }} :<br>
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{{ form.address_complement }} |
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{{ form.address_complement.errors }} |
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</td>
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</tr>
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<tr>
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<td>
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{{ form.zip_code.label_tag }} :<br>
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{{ form.zip_code }} |
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{{ form.zip_code.errors }} |
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</td>
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<td>
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{{ form.city.label_tag }} :<br>
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{{ form.city }} |
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{{ form.city.errors }} |
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</td>
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</tr>
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<tr>
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<td>
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{{ form.phone.label_tag }} :<br>
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{{ form.phone }} |
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{{ form.phone.errors }} |
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</td>
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<td>
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{{ form.fax.label_tag }} :<br>
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{{ form.fax }} |
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{{ form.fax.errors }} |
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</td>
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</tr>
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</tbody>
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</table>
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<br>
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<p>
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{{ form.place_of_life.label_tag }} |
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{{ form.place_of_life }} |
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{{ form.place_of_life.errors }} |
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</p>
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<p>
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{{ form.comment.label_tag }} {{ form.comment }} |
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{{ form.comment.errors }} |
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</p>
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</form>
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