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Direktori : /proc/self/root/home/importfo/public_html/advancedentalcancerhospital.com/ |
Current File : //proc/self/root/home/importfo/public_html/advancedentalcancerhospital.com/appointment.php |
<!DOCTYPE html> <html dir="ltr" lang="en"> <head> <!-- Meta Tags --> <meta name="viewport" content="width=device-width,initial-scale=1.0"/> <meta http-equiv="content-type" content="text/html; charset=UTF-8"/> <meta name="description" content="DentalPlus - Dental Care HTML5 Template" /> <meta name="keywords" content="building,business,construction,cleaning,transport,workshop" /> <meta name="author" content="ThemeMascot" /> <!-- Page Title --> <title>ICONIC 32 Dental Care</title> <!-- Favicon and Touch Icons --> <link href="images/favicon.png" rel="shortcut icon" type="image/png"> <link href="images/apple-touch-icon.png" rel="apple-touch-icon"> <link href="images/apple-touch-icon-72x72.png" rel="apple-touch-icon" sizes="72x72"> <link href="images/apple-touch-icon-114x114.png" rel="apple-touch-icon" sizes="114x114"> <link href="images/apple-touch-icon-144x144.png" rel="apple-touch-icon" sizes="144x144"> <!-- Stylesheet --> <link href="css/bootstrap.min.css" rel="stylesheet" type="text/css"> <link href="css/jquery-ui.min.css" rel="stylesheet" type="text/css"> <link href="css/animate.css" rel="stylesheet" type="text/css"> <link href="css/css-plugin-collections.css" rel="stylesheet"/> <!-- CSS | menuzord megamenu skins --> <link id="menuzord-menu-skins" href="css/menuzord-skins/menuzord-boxed.css" rel="stylesheet"/> <!-- CSS | Main style file --> <link href="css/style-main.css" rel="stylesheet" type="text/css"> <!-- CSS | Preloader Styles --> <link href="css/preloader.css" rel="stylesheet" type="text/css"> <!-- CSS | Custom Margin Padding Collection --> <link href="css/custom-bootstrap-margin-padding.css" rel="stylesheet" type="text/css"> <!-- CSS | Responsive media queries --> <link href="css/responsive.css" rel="stylesheet" type="text/css"> <!-- CSS | Style css. This is the file where you can place your own custom css code. Just uncomment it and use it. --> <!-- <link href="css/style.css" rel="stylesheet" type="text/css"> --> <!-- CSS | Theme Color --> <link href="css/colors/theme-skin-blue4.css" rel="stylesheet" type="text/css"> <!-- external javascripts --> <script src="js/jquery-2.2.4.min.js"></script> <script src="js/jquery-ui.min.js"></script> <script src="js/bootstrap.min.js"></script> <!-- JS | jquery plugin collection for this theme --> <script src="js/jquery-plugin-collection.js"></script> <style> #select-box { height: 30px; overflow-y: auto; /* width: 50px;*/ } option { overflow-y: scroll; } </style> </head> <body class=""> <div id="wrapper" class="clearfix"> <!-- preloader --> <!-- Start main-content --> <div class="main-content"> <!-- Section: home --> <section id="home" class="divider parallax layer-overlay overlay-dark-9" data-bg-img="images/bg/bg4.jpg"> <div class="display-table"> <div class="display-table-cell"> <div class="container pb-100"> <div class="row"> <div class="col-md-6 col-md-push-3"> <!-- <div class="text-center mb-60"><a href="#" class=""><img alt="" src="images/logo.jpg"></a></div> --> <div class="bg-lightest border-1px p-25"> <h4 class="text-theme-colored text-uppercase m-0">Make an Appointment</h4> <div class="line-bottom mb-30"></div> <!-- <p>Lorem ipsum dolor sit amet, consectetur elit.</p> --> <form class="mt-30" action="inquiry.php" method="post"> <div class="row"> <div class="col-sm-12"> <div class="form-group mb-10"> <input name="name" class="form-control" type="text" required="" placeholder="Enter Full 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="contact" class="form-control required" type="text" placeholder="Enter Phone" aria-required="true"> </div> </div> <div class="col-sm-12"> <div class="form-group mb-10"> <input name="adate" class="form-control required date-picker" type="text" placeholder="Appointment Date" aria-required="true"> </div> </div> <div class="col-sm-12"> <div class="form-group mb-10"> <!-- <input name="atime" class="form-control required time-picker" type="text" placeholder="Appointment Time" aria-required="true"> --> <select name="atime" id="select-box" type="text" placeholder="Appointment Time" aria-required="true" class="form-control required "> <option>Select Time</option> <option>10:00 am</option> <option>10:30 am</option> <option>11:00 am</option> <option>11:30 am</option> <option>12:00 pm</option> <option>12:30 pm</option> <option>1:00 pm</option> <option>1:30 pm</option> <option>2:00 pm</option> <option>2:30 pm</option> <option>3:00 pm</option> <option>3:30 pm</option> <option>4:00 pm</option> <option>4:30 pm</option> <option>5:00 pm</option> <option>5:30 pm</option> <option>6:00 pm</option> <option>6:30 pm</option> <option>7:00 pm</option> <option>7:30 pm</option> <option>8:00 pm</option> <option>8:30 pm</option> <option>9:00 pm</option> <option>9:30 pm</option> <option>10:00 pm</option> </select> </div> </div> </div> <div class="form-group mb-10"> <textarea name="msg" class="form-control required" placeholder="Enter Message" rows="5" aria-required="true"></textarea> </div> <div class="form-group mb-0 mt-20"> <input name="submit" class="form-control" type="hidden" value=""> <button type="submit" class="btn btn-dark btn-theme-colored" >Submit</button> </div> </form> <!-- Appointment Form Validation--> <script type="text/javascript"> $("#appointment_form").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> </div> </div> </div> </div> </div> </section> </div> <!-- end main-content --> <!-- Footer --> <a class="scrollToTop" href="#"><i class="fa fa-angle-up"></i></a> </div> <!-- end wrapper --> <script src="js/custom.js"></script> </body> </html>