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Current File : /home2/ppcad7no/fastelevator.in/../shantamchestsleep.org/enquiry.php
<html>
<head>
    <title>Enquiry | Shantam Chest & Sleep Disorders</title>
    <meta name="keywords" content="">
	<meta name="description" content="Enquiry | Shantam Chest & Sleep Disorders">
    <meta name="viewport" content="width=device-width, initial-scale=1.0, user-scalable=no">
	<?php include 'top-link.php';?>
	
</head>
  <body>
  <div id="wrap">
 <?php include 'header.php';?>
 <div class="container">
  <section style="background:url(images/slides/abt-bg.jpg) no-repeat center; background-size:cover;">
      <div class="container">
         <div class="row">
             <div class="col-md-12 abt-pg">
                <h2>Enquiry</h2>
                <p><a href="index.php">Home</a> | Enquiry</p>
           </div>
       </div>
    </div>
</section>
    
    <div class="make-appointment">
   <div class="container">
   
    <ul id="accordion" class="accordion">
  <li>
    
    <div class="link"><i class="fa fa-database"></i><span class="appointment-title">Make an Appointment</span> <i class="icon-chevron-down"></i> </div>
    
    <section class="bgcolor-3">
    
   <h2 class="mk-apt">Please call on <span>+91 8368783807 / 9971204999</span> to Book an Appointment</h2> 
			</section>
  </li>
  
</ul>
    </div>
    </div>
     <!--Start Content-->
   <div class="content">
   
   
  
  <div class="contact-us">
   		
		
		
		<div class="leave-msg dark-back">
			<div class="container">
			
			<div class="rox">
            <div class="col-md-4 bg-cnt hidden-xs">
                <img src="images/enquiry.png">
				</div>
               
                
				<div class="col-md-8">
                <div class="form">
				<div class="row">
                                    <p class="success" id="success" style="display:none;"></p>
                                    <p class="error" id="error" style="display:none;"></p>
                <form name="contact_form" id="contact_form" method="post" action="#" onSubmit="return false">
					
                    <div class="col-md-6"><input type="text" data-delay="300" placeholder="Your full name" name="contact_name" id="contact_name" class="input"></div>
					<div class="col-md-6"><input type="text" data-delay="300" placeholder="Mobile No" name="contact_subject" id="contact_subject" class="input"></div>
                    <div class="col-md-12"><input type="text" data-delay="300" placeholder="E-mail Address" name="contact_email" id="contact_email" class="input"></div>
					
                    <div class="col-md-12"><input type="text" data-delay="300" placeholder="Subject" name="contact_subject" id="contact_subject" class="input"></div>
					<div class="col-md-12"><textarea data-delay="500" class="required valid" placeholder="Message" name="message" id="message"></textarea></div>
					<div class="col-md-3"><input name=" " type="submit" value="Send Your Mesage" onClick="validateContact();"></div>
                    </form>
                    
				</div>
			</div>

					
				</div>
				
				
			</div>

			</div>
		</div>
		
   </div>
  
   
   </div>
<?php include 'footer.php';?>

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