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Mini Shell

Direktori : /home/importfo/public_html/advancedentalcancerhospital.com/ajax-load/
Upload File :
Current File : //home/importfo/public_html/advancedentalcancerhospital.com/ajax-load/form-appointment.html

<section class="">
  <div class="container" style="max-width: 700px;">
    <h3 class="bg-theme-colored p-15 mb-0 text-white">Appointment Form</h3>
    <div class="section-content bg-white p-30">
      <div class="row">
        <div class="col-md-12">
          <form id="appointment_form_popup" name="appointment_form_popup" class="" method="post" action="https://kodesolution.com/html/2016/dentalplus-html/demo/ajax-load/includes/appointment.php">
            <div class="row">
              <div class="col-sm-12">
                <div class="form-group mb-10">
                  <input name="form_name" class="form-control" type="text" required="" placeholder="Enter Name" aria-required="true">
                </div>
              </div>
              <div class="col-sm-12">
                <div class="form-group mb-10">
                  <input name="form_email" class="form-control required email" type="email" placeholder="Enter Email" aria-required="true">
                </div>
              </div>
              <div class="col-sm-12">
                <div class="form-group mb-10">
                  <input name="form_appontment_date" class="form-control required date-picker" type="text" placeholder="Appoinment Date" aria-required="true">
                </div>
              </div>
            </div>
            <div class="form-group mb-10">
              <textarea name="form_message" class="form-control required"  placeholder="Enter Message" rows="3" aria-required="true"></textarea>
            </div>
            <div class="form-group mb-0 mt-20">
              <input name="form_botcheck" class="form-control" type="hidden" value="">
              <button type="submit" class="btn btn-dark btn-theme-colored" data-loading-text="Please wait...">Send Message</button>
            </div>
          </form>

          <script type="text/javascript">
            $("#appointment_form_popup").validate({
              submitHandler: function(form) {
                var form_btn = $(form).find('button[type="submit"]');
                var form_result_div = '#form-result';
                $(form_result_div).remove();
                form_btn.before('<div id="form-result" class="alert alert-success" role="alert" style="display: none;"></div>');
                var form_btn_old_msg = form_btn.html();
                form_btn.html(form_btn.prop('disabled', true).data("loading-text"));
                $(form).ajaxSubmit({
                  dataType:  'json',
                  success: function(data) {
                    if( data.status == 'true' ) {
                      $(form).find('.form-control').val('');
                    }
                    form_btn.prop('disabled', false).html(form_btn_old_msg);
                    $(form_result_div).html(data.message).fadeIn('slow');
                    setTimeout(function(){ $(form_result_div).fadeOut('slow') }, 6000);
                  }
                });
              }
            });
          </script>
        </div>
        <script>
          //reload date and time picker
          THEMEMASCOT.initialize.TM_datePicker();
        </script>
      </div>
    </div>
  </div>
</section>

Zerion Mini Shell 1.0