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Mini Shell

Direktori : /home/importfo/public_html/sapphiredentalcare.in/
Upload File :
Current File : /home/importfo/public_html/sapphiredentalcare.in/form.php

<div class="quickLinks-wrap js-quickLinks-wrap-d d-none d-lg-flex">
		<div class="quickLinks js-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!1d14679.803268931004!2d72.5394429!3d23.0988962!3m2!1i1024!2i768!4f13.1!3m3!1m2!1s0x395e83ecad8097af%3A0x4ed586ea70884896!2sSAPPHIRE%20DENTAL%20CARE!5e0!3m2!1sen!2sin!4v1692333354054!5m2!1sen!2sin" width="100%" height="400" 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>	10am–1pm, 5pm–8pm</td>
										</tr>
										<tr>
											<td><i>Sunday</i></td>
											<td> Close</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>
										<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="requestname" 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="requestemail" 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="requestphone" 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>
												<input type="text" name="" class="form-control" placeholder="services" >
										</div>
										<div class="row row-sm-space mt-1">
											<div class="col-sm-6">
												<div class="input-group flex-nowrap">
													<span>
														<i class="icon-calendar2"></i>
													</span>
													<div class="datepicker-wrap">
														<input name="requestdate" type="text" class="form-control datetimepicker" placeholder="Date" readonly>
													</div>
												</div>
											</div>
											<div class="col-sm-6 mt-1 mt-sm-0">
												<div class="input-group flex-nowrap">
													<span>
															<i class="icon-clock"></i>
													</span>
													<div class="datepicker-wrap">
														<input name="requesttime" type="text" class="form-control timepicker" placeholder="Time" readonly>
													</div>
												</div>
											</div>
										</div>
										<div class="text-right mt-2">
											<button type="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>Conatact Us</h5>
							<!-- <p>Admission Mediclaim/ cashless facility also available</p> -->
							<ul class="icn-list">
								<li><i class="icon-telephone"></i><span class="phone">+91 91065 03056</span>
								</li>
								<li><i class="icon-black-envelope"></i><a href="mailto:dentalcaresapphire@gmail.com">dentalcaresapphire@gmail.com</a></li>
							</ul>
							<p class="text-right mt-2"><a href="contact.php" class="btn btn-sm btn-hover-fill">Our Contacts</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