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Current File : /home2/ppcad7no/shantamdiabetes.org/enquiry.php
<!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>

MMCT - 2023