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Mini Shell

Direktori : /home/importfo/public_html/citysmiledentalstudio.com/
Upload File :
Current File : /home/importfo/public_html/citysmiledentalstudio.com/form.php

<div class="quickLinks-wrap js-quickLinks-wrap-d d-none d-lg-flex">
		<div class="quickLinks">
			<div class="container">
				<div class="row no-gutters">
					<div class="col">
						<a href="#" class="link">
							<i class="icon-placeholder"></i><span>Location</span></a>
						<div class="link-drop p-0">
						<div class="map-responsive">
                        <iframe src="https://www.google.com/maps/embed?pb=!1m14!1m8!1m3!1d14681.92239758255!2d72.5025281!3d23.0794963!3m2!1i1024!2i768!4f13.1!3m3!1m2!1s0x395e9d70534ffdff%3A0x68e5986b9dda2a0e!2sCitySmile%20Dental%20Studio!5e0!3m2!1sen!2sin!4v1690960024355!5m2!1sen!2sin" width="100%" height="450" style="border:0;" allowfullscreen="" loading="lazy" referrerpolicy="no-referrer-when-downgrade"></iframe>
                    </div>
						</div>
					</div>
					<div class="col">
						<a href="#" class="link">
							<i class="icon-clock"></i><span>Working Time</span>
						</a>
						<div class="link-drop">
							<h5 class="link-drop-title"><i class="icon-clock"></i>Working Time</h5>
							<table class="row-table">
										<tr>
											<td><i>Mon-Sat</i></td>
											<td>9:30 AM – 1:00 PM,
											<br/>4:00 PM – 8:00 PM</td>
										</tr>
										<tr>
											<td><i>Sunday</i></td>
											<td>As Per Appointment</td>
										</tr>
									
							</table>
						</div>
					</div>
					<div class="col">
						<a href="#" class="link">
							<i class="icon-pencil-writing"></i><span>Request Form</span>
						</a>
						<div class="link-drop">
							<h5 class="link-drop-title"><i class="icon-pencil-writing"></i>Request Form</h5>
							<!--<form id="requestForm" method="post" novalidate>-->
							<form  action="inquiry.php" method="post">
										<div class="successform">
											<p>Your Message Was Sent Successfully!</p>
										</div>
										<div class="errorform">
											<p>Something went wrong, try refreshing and submitting the form again.</p>
										</div>
										<div class="input-group">
											<span>
											<i class="icon-user"></i>
										</span>
											<input name="name" type="text" class="form-control" placeholder="Your Name" />
										</div>
										<div class="row row-sm-space mt-1">
											<div class="col">
												<div class="input-group">
													<span>
													<i class="icon-email2"></i>
												</span>
													<input name="email" type="text" class="form-control" placeholder="Your Email" />
												</div>
											</div>
											<div class="col">
												<div class="input-group">
													<span>
													<i class="icon-smartphone"></i>
												</span>
													<input name="contact" type="text" class="form-control" placeholder="Your Phone" />
												</div>
											</div>
										</div>
										<div class="selectWrapper input-group mt-1">
											<span>
											<i class="icon-right-arrow"></i>
										</span>
											<select name="msg" class="form-control">
												<option selected="selected" disabled="disabled">Select Service</option>
									            <option value="Root Canal Treatment">Consultation</option>
												<option value="Root Canal Treatment">Cosmetic Dentistry</option>
												<option value="Dental Smile Design Treatment">Digital Smile Designing</option>
												<option value="Dental Crowns And Bridges Treatment">Full Mouth Rehabilitation</option>
												<option value="Dental Implant Center">Dental Implant </option>
												<option value="Teeth Whitening Treatment">Root Canal Treatment</option>
												<option value="Denture Treatment">Laser Gum Surgery </option>
												<option value="Dental Implant Center">Laser Whitening  </option>
												<option value="Teeth Whitening Treatment">Orthodontic Treatment</option>
												<option value="Denture Treatment">Paediatric Dentistry </option>
												<option value="Denture Treatment">Wisdom Tooth Removal Surgery </option>
												<option value="Denture Treatment">Other</option>
											</select>
										</div>
										
										<div class="text-right mt-2">
											<button type="submit"  name="submit" class="btn btn-sm btn-hover-fill">Request</button>
										</div>
									</form>
						</div>
					</div>
				
					<div class="col">
						<a href="#" class="link">
							<i class="icon-emergency-call"></i><span>Contact</span></a>
						<div class="link-drop">
							<h5 class="link-drop-title"><i class="icon-emergency-call"></i>Contact Us</h5>
							<!-- <p>Admission Mediclaim/ cashless facility also available</p> -->
							<ul class="icn-list">
								<li><i class="icon-telephone"></i><span class="phone">
							+91 99981 83009</span>
								</li>
								<li><i class="icon-black-envelope"></i><a href="mailto:citysmiledentalstudio@gmail.com">citysmiledentalstudio@gmail.com</a></li>
							</ul>
							<p class="text-right mt-2"><a href="tel:+919998183009" class="btn btn-sm btn-hover-fill">Call now</a></p>
						</div>
					</div>
					<div class="col col-close"><a href="#" class="js-quickLinks-close"><i class="icon-top" data-toggle="tooltip" data-placement="top" title="Close panel"></i></a></div>
				</div>
			</div>
			<div class="quickLinks-open js-quickLinks-open"><span data-toggle="tooltip" data-placement="left" title="Open panel">+</span></div>
		</div>
	</div>

Zerion Mini Shell 1.0