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<!DOCTYPE html>
<head>
<meta name="viewport" content="width=device-width,initial-scale=1.0"/>
<title>Enquiry - Shantam Diabetes & Medical Center</title>
<meta name="description" content="Enquiry - Shantam Diabetes & Medical Center in Paschim Vihar, Delhi"/>
<meta name="keywords" content="" />
<meta name="page-topic" content="Enquiry">
<?php include 'top-link.php';?>
<style>
.service-icon-box a {
height: 45px;
width: 40px;
line-height: 57px;
}
.mb-0d {
margin-bottom: 0!important;
padding-top: 10px;
}
.d-mt {
margin-top: 10px !important;
}
.pd-10 {
padding: 10px;
}
</style>
</head>
<body class="">
<div id="wrapper">
<div id="preloader">
<div id="spinner">
<div class="preloader-dot-loading">
<div class="cssload-loading"><i></i><i></i><i></i><i></i></div>
</div>
</div>
<div id="disable-preloader" class="btn btn-default btn-sm">Disable Preloader</div>
</div>
<?php include 'header.php'?>
<div class="main-content">
<section class="inner-header divider parallax layer-overlay overlay-white-5" data-bg-img="images/bg/b1.jpg">
<div class="container pt-60 pb-60">
<div class="section-content">
<div class="row">
<div class="col-md-12 text-center">
<h2 class="title">Enquiry</h2>
<ol class="breadcrumb text-center text-black mt-10">
<li><a href="index.php">Home</a></li>
<li class="active text-theme-colored">Enquiry</li>
</ol>
</div>
</div>
</div>
</div>
</section>
<section class="divider">
<div class="container">
<div class="row pt-30">
<div class="col-md-4">
<div class="row">
<div class="col-xs-12 col-sm-6 col-md-12">
<img src="images/enquiry.png" class="img-responsive">
</div>
</div>
</div>
<div class="col-md-8">
<h3 class="line-bottom mt-0 mb-30">Interested in discussing?</h3>
<form id="contact_form" name="contact_form" class="" action="" method="post">
<div class="row">
<div class="col-sm-12">
<div class="form-group">
<label>Name <small>*</small></label>
<input name="form_name" class="form-control" type="text" placeholder="Enter Name" required>
</div>
</div>
<div class="col-sm-12">
<div class="form-group">
<label>Email <small>*</small></label>
<input name="form_email" class="form-control required email" type="email" placeholder="Enter Email">
</div>
</div>
</div>
<div class="row">
<div class="col-sm-6">
<div class="form-group">
<label>Subject <small>*</small></label>
<input name="form_subject" class="form-control required" type="text" placeholder="Enter Subject">
</div>
</div>
<div class="col-sm-6">
<div class="form-group">
<label>Phone</label>
<input name="form_phone" class="form-control" type="text" placeholder="Enter Phone">
</div>
</div>
</div>
<div class="form-group">
<label>Message</label>
<textarea name="form_message" class="form-control required" rows="5" placeholder="Enter Message"></textarea>
</div>
<div class="form-group">
<input name="form_botcheck" class="form-control" type="hidden" value="" />
<button type="submit" class="btn btn-dark btn-theme-colored btn-flat mr-5" data-loading-text="Please wait...">Send your message</button>
<button type="reset" class="btn btn-default btn-flat btn-theme-colored">Reset</button>
</div>
</form>
<script>
$("#contact_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.php();
form_btn.php(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).php(form_btn_old_msg);
$(form_result_div).php(data.message).fadeIn('slow');
setTimeout(function(){ $(form_result_div).fadeOut('slow') }, 6000);
}
});
}
});
</script>
</div>
</div>
</div>
</section>
</div>
<section style="background-color:#0cb8b6; padding:10px;">
<div class="container" style="padding:10px 0px;">
<div class="row">
<div class="col-md-10">
<h2 style="color:#fff;">Get In Touch With Us!!!!</h2>
</div>
<div class="col-md-2"> <a class="rd-mr" href="contact-us.php" style="position:relative; top:25px;">Contact Us <i class="fa fa-angle-double-right"></i></a> </div>
</div>
</div>
</section>
<?php include 'footer.php'?>
<a class="scrollToTop" href="#"><i class="fa fa-angle-up"></i></a>
</div>
<script src="js/custom.js"></script>
</body>
</html>