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Current File : /home2/ppcad7no/naturewoodfloor.in/../tmp/../joshidiagnosticcentre.com/consultant.php
<?php
   
   if(isset($_POST['submit'])) 
   { 
   
       $name = $_POST['name'];
       $phone = $_POST['phone'];
       $service = $_POST['service'];

        $sql= " INSERT INTO `consultant_page`(`name`, `phone`, `service`) VALUES ('$name','$phone','$service')";
       // echo "<br> <h1>No image</h1>";
   
       $result = mysqli_query($db, $sql) or die("Query unsuccessful");
       // echo "<br> <h1>No image</h1>";
   
       if($result){
         echo ("<script>
          window.alert('Succesfully Submitted');
          window.location.href='index.html';
          </script>");
        
          mysqli_close($db);
       }else{
       //    
       echo "Not Submitted";
       }
    }
?>
<section class="py-3 py-md-4 py-lg-5">
        <div class="container">
            <div class="row">
                <div class="col-lg-6">
                    <div class="card shadow mb-3 mb-lg-0">
                        <div class="card-body">
                            <h5 class="card-title">
                                <a class="text-secondary" >Talk to a consultant</a>
                            </h5>
                            <p class="card-text mb-3 mb-md-4 mb-lg-5">
                                Submit your requirement with us and speak to one of our expert healthcare consultants.
                            </p>
                            <form id="inquiry-form" action="<?php $_PHP_SELF?>" method="POST">
                                <div class="form-group">
                                    <label for="requirement-name">Name <span class="text-danger">&ast;</span></label>
                                    <input type="text" class="form-control form-control-lg " id="requirement-name" name="name" required>
                                </div>
                                <div class="form-group">
                                    <label for="requirement-phone">Phone number <span class="text-danger">&ast;</span></label>
                                    <input class="form-control form-control-lg " id="requirement-phone" name="phone" required type="tel">
                                </div>
                                <div class="form-group">
                                    <label for="requirement-service-attendant">Service <span class="text-danger">&ast;</span></label>
                                    <div class="custom-control custom-radio">
                                        <input type="radio" id="requirement-service-doc" name="service" class="custom-control-input" value="Digital X-Ray">
                                        <label class="custom-control-label" for="requirement-service-doc">Digital X-Ray</label>
                                    </div>
                                    <div class="custom-control custom-radio">
                                        <input type="radio" id="requirement-service-nurse" name="service"
                                            class="custom-control-input" value="ECG">
                                        <label class="custom-control-label" for="requirement-service-nurse">ECG</label>
                                    </div>
                                    <div class="custom-control custom-radio">
                                        <input type="radio" id="requirement-service-attendant" name="service"
                                            class="custom-control-input" value="Full Body Checkup" checked>
                                        <label class="custom-control-label" for="requirement-service-attendant">Full Body Checkup</label>
                                    </div>
                                    <div class="custom-control custom-radio">
                                        <input type="radio" id="requirement-service-physiotherapist" name="service"
                                            class="custom-control-input" value="Thyroid Profile">
                                        <label class="custom-control-label"
                                            for="requirement-service-physiotherapist">Thyroid Profile</label>
                                    </div>
                                    <!-- <div class="custom-control custom-radio">
                                        <input type="radio" id="requirement-service-test" name="service"
                                            class="custom-control-input" value="Test">
                                        <label class="custom-control-label" for="requirement-service-test">Lab tests</label>
                                    </div> -->
                                </div>
                                <button class="btn btn-secondary btn-lg" name="submit"> Submit <i class="fas fa-arrow-right ml-1"></i>
                                </button>
                            </form>
                        </div>
                    </div>
                </div>
                <div class="col-lg-6">
                    <div class="card bg-primary text-white mb-3">
                        <div class="card-body">
                            <p class="card-title text-uppercase h5"><strong>Complete Healthcare</strong></p>
                            <p class="card-text">Get expert medical care from a service provider trusted by
                                many families for our passion towards caring.</p>
                            <ul class="fa-ul">
                                <li><span class="fa-li"><i class="fas fa-prescription"></i></span> Qualified,
                                    mannered staff.</li>
                                <li><span class="fa-li"><i class="fas fa-prescription"></i></span> On-time
                                    fulfilment and instant replacement.</li>
                                <li><span class="fa-li"><i class="fas fa-prescription"></i></span> Prompt,
                                    satisfactory helpline.</li>
                            </ul>
                            <a class="btn btn-dark btn-lg" href="<?php echo $wspath ?>contact.html">Submit a
                                Requirement
                                <i class="fas fa-arrow-right ml-1"></i></a>
                        </div>
                    </div>
                    <div class="card bg-dark text-white">
                        <div class="card-body">
                            <p class="card-title text-uppercase h5"><strong>More Medical Services</strong></p>
                            <p class="card-text">In need someone for an urgent injection or something else? Our expert
                                is just a call away.</p>
                            <ul class="fa-ul">
                                <li><span class="fa-li"><i class="fas fa-prescription"></i></span> Hormones Test.</li>
                                <li><span class="fa-li"><i class="fas fa-prescription"></i></span> Urine Test.</li>
                                <li><span class="fa-li"><i class="fas fa-prescription"></i></span> LFT.</li>
                            </ul>
                            <a class="btn btn-primary btn-lg" href="<?php echo $wspath ?>contact.html">
                                Contact us <i class="fas fa-arrow-right ml-1"></i>
                            </a>
                        </div>
                    </div>
                </div>
            </div>
        </div>
    </section>

MMCT - 2023