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Mini Shell

Direktori : /home/importfo/public_html/advancedentalcancerhospital.com/
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Current File : //home/importfo/public_html/advancedentalcancerhospital.com/a.php

<!DOCTYPE html>
<html>
<head>
  <title>Appointment Form</title>
  <style>
    /* Styles for the form */
    #appointmentForm {
      max-width: 400px;
      margin: 0 auto;
      padding: 20px;
      background: #f1f1f1;
      border: 1px solid #ccc;
      border-radius: 4px;
    }
    
    #appointmentForm h2 {
      text-align: center;
    }
    
    #appointmentForm label {
      display: block;
      margin-bottom: 10px;
    }
    
    #appointmentForm input[type="text"],
    #appointmentForm input[type="email"],
    #appointmentForm textarea {
      width: 100%;
      padding: 5px;
      border: 1px solid #ccc;
      border-radius: 4px;
      box-sizing: border-box;
      resize: vertical;
    }
    
    #appointmentForm button[type="submit"] {
      background: #4CAF50;
      color: white;
      padding: 10px 20px;
      border: none;
      border-radius: 4px;
      cursor: pointer;
      float: right;
    }
  </style>
</head>
<body>
  
  <!-- The appointment form -->
  <div id="appointmentForm">
    <h2>Appointment Form</h2>
    <form>
      <label for="name">Name:</label>
      <input type="text" id="name" name="name" required>

      <label for="email">Email:</label>
      <input type="email" id="email" name="email" required>

      <label for="phone">Phone:</label>
      <input type="text" id="phone" name="phone" required>

      <label for="message">Message:</label>
      <textarea id="message" name="message" rows="4"></textarea>

      <button type="submit">Submit</button>
    </form>
  </div>

</body>
</html>

Zerion Mini Shell 1.0