Book Appoinment
Forms
-- Style 1 --
<form class="contact quform" action="quform/contact.php" method="post" enctype="multipart/form-data" onclick="">
<div class="quform-elements">
<div class="row">
<!-- Begin Text input element -->
<div class="col-md-6">
<div class="quform-element form-group">
<label for="name">Your Name <span class="quform-required">*</span></label>
<div class="quform-input">
<input class="form-control" id="name_one" type="text" name="name" placeholder="Your name here" />
</div>
</div>
</div>
<!-- End Text input element -->
<!-- Begin Text input element -->
<div class="col-md-6">
<div class="quform-element form-group">
<label for="email">Your Email <span class="quform-required">*</span></label>
<div class="quform-input">
<input class="form-control" id="email_one" type="text" name="email" placeholder="Your email here" />
</div>
</div>
</div>
<!-- End Text input element -->
<!-- Begin Text input element -->
<div class="col-md-6">
<div class="quform-element form-group">
<label for="subject_one">Your Subject <span class="quform-required">*</span></label>
<div class="quform-input">
<input class="form-control" id="subject_one" type="text" name="subject" placeholder="Your subject here" />
</div>
</div>
</div>
<!-- End Text input element -->
<!-- Begin Text input element -->
<div class="col-md-6">
<div class="quform-element form-group">
<label for="phone">Contact Number</label>
<div class="quform-input">
<input class="form-control" id="phone_one" type="text" name="phone" placeholder="Your phone here" />
</div>
</div>
</div>
<!-- End Text input element -->
<!-- Begin Textarea element -->
<div class="col-md-12">
<div class="quform-element form-group">
<label for="message">Message <span class="quform-required">*</span></label>
<div class="quform-input">
<textarea class="form-control h-100" id="message_one" name="message" rows="3" placeholder="Tell us a few words"></textarea>
</div>
</div>
</div>
<!-- End Textarea element -->
<!-- Begin Captcha element -->
<div class="col-md-12">
<div class="quform-element">
<div class="form-group">
<div class="quform-input">
<input class="form-control" id="type_the_word_one" type="text" name="type_the_word" placeholder="Type the below word" />
</div>
</div>
<div class="form-group">
<div class="quform-captcha">
<div class="quform-captcha-inner">
<img src="quform/images/captcha/courier-new-light.png" alt="...">
</div>
</div>
</div>
</div>
</div>
<!-- End Captcha element -->
<!-- Begin Submit button -->
<div class="col-md-12">
<div class="quform-submit-inner">
<button class="butn secondary" type="submit"><span>Send Message</span></button>
</div>
<div class="quform-loading-wrap text-start"><span class="quform-loading"></span></div>
</div>
<!-- End Submit button -->
</div>
</div>
</form>
-- Style 2 --
<form class="quform" action="quform/book-appointment.php" method="post" enctype="multipart/form-data" onclick="">
<div class="quform-elements">
<div class="row">
<!-- Begin Text input element -->
<div class="col-sm-6">
<div class="quform-element form-group">
<div class="quform-input">
<input class="form-control" id="name_two" type="text" name="name" placeholder="First Name" />
</div>
</div>
</div>
<!-- End Text input element -->
<!-- Begin Text input element -->
<div class="col-sm-6">
<div class="quform-element form-group">
<div class="quform-input">
<input class="form-control" id="last_name_two" type="text" name="last_name" placeholder="Last Name" />
</div>
</div>
</div>
<!-- End Text input element -->
<!-- Begin Text input element -->
<div class="col-sm-6">
<div class="quform-element form-group">
<div class="quform-input">
<input class="form-control" id="phone_two" type="text" name="phone" placeholder="Your phone number" />
</div>
</div>
</div>
<!-- End Text input element -->
<!-- Begin Text input element -->
<div class="col-sm-6">
<div class="quform-element form-group">
<div class="quform-input">
<input class="form-control" id="email_two" type="text" name="email" placeholder="Your email" />
</div>
</div>
</div>
<!-- End Text input element -->
<!-- Begin Text input element -->
<div class="col-sm-6">
<div class="quform-element form-group">
<div class="quform-input">
<input class="form-control date form_date" data-date-format="dd MM yyyy" data-link-format="yyyy-mm-dd" size="16" type="text" id="date_two" name="date" value="" placeholder="Appoinment date">
</div>
</div>
</div>
<!-- End Text input element -->
<!-- Begin Text input element -->
<div class="col-sm-6">
<div class="quform-element form-group">
<div class="quform-input">
<input class="form-control date form_time" data-date="" data-date-format="hh:ii" data-link-format="hh:ii" size="16" type="text" id="time_two" name="time" value="" placeholder="Appoinment time">
</div>
</div>
</div>
<!-- End Text input element -->
<!-- Begin Select element -->
<div class="col-sm-6">
<div class="quform-element form-group">
<div class="quform-input">
<select class="form-control form-select" id="department_two" name="department">
<option value="">-- Select Department --</option>
<option value="Cardiology">Cardiology</option>
<option value="Gynecology">Gynecology</option>
<option value="Neurology">Neurology</option>
<option value="Orthopedics">Orthopedics</option>
<option value="Pulmonology">Pulmonology</option>
<option value="Gastrology">Gastrology</option>
<option value="Urology">Urology</option>
<option value="Laboratory">Laboratory</option>
<option value="Others">Others</option>
</select>
</div>
</div>
</div>
<!-- End Select element -->
<!-- Begin Text input element -->
<div class="col-sm-6">
<div class="quform-element form-group">
<div class="quform-input">
<select class="form-control form-select" id="doctors_two" name="doctors">
<option value="">-- Choose Your Doctor --</option>
<option value="Jama Karle">Jama Karle</option>
<option value="Keir Prestonly">Keir Prestonly</option>
<option value="Finley Walkeror">Finley Walkeror</option>
<option value="Dont know">Dont know</option>
</select>
</div>
</div>
</div>
<!-- End Text input element -->
<!-- Begin Textarea element -->
<div class="col-md-12">
<div class="quform-element form-group">
<div class="quform-input">
<textarea class="form-control" id="message_two" name="message" rows="3" placeholder="Message"></textarea>
</div>
</div>
</div>
<!-- End Textarea element -->
<!-- Begin Captcha element -->
<div class="col-md-12">
<div class="quform-element">
<div class="form-group">
<div class="quform-input">
<input class="form-control" id="type_the_word_two" type="text" name="type_the_word" placeholder="Type the below word" />
</div>
</div>
<div class="form-group">
<div class="quform-captcha">
<div class="quform-captcha-inner">
<img src="quform/images/captcha/courier-new-light.png" alt="...">
</div>
</div>
</div>
</div>
</div>
<!-- End Captcha element -->
<!-- Begin Submit button -->
<div class="col-md-12">
<div class="quform-submit-inner text-center">
<button class="butn border-0 w-100" type="submit"><span>Submit Now</span></button>
</div>
<div class="quform-loading-wrap"><span class="quform-loading"></span></div>
</div>
<!-- End Submit button -->
</div>
</div>
</form>