<form action="/pages/prescription-confirmation" method="post" enctype="multipart/form-data">
  <label for="prescription">Upload Prescription:</label>
  <input type="file" id="prescription" name="prescription" accept="image/*,.pdf" required>
  <br>
  <label for="patient-name">Patient Name:</label>
  <input type="text" id="patient-name" name="patient-name" required>
  <br>
  <label for="doctor-name">Doctor Name:</label>
  <input type="text" id="doctor-name" name="doctor-name" required>
  <br>
  <button type="submit">Submit Prescription</button>
</form>