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<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>
<?php $timeArray = array('1'=>"Less than 10 minutes",'2'=>"10-15 minutes",'3'=>"15-20 minutes",'4'=>"20-30 minutes",'5'=>"More than 30 minutes"); ?>
<div class="sec-newd">
<div class="new-var">
<div class="login-logo">
<img src="<?=base_url('assests/imgs/Sharda-Hospital-Logo.png')?>">
</div>
<form method="post" action="<?=base_url('survey')?>">
<h2>Sharda Hospital Survey Form </h2>
<div class="row">
<div class="englhindi">
<span>Select Language (भाषा चुने) : </span>
<a href="javascript:void(0)"><input type="radio" name="language" value="1" checked> <small>English </small></a>
<a href="<?=base_url('survey/hindi')?>"><input type="radio" name="language" value="2"><small> हिन्दी </small></a>
</div>
</div>
<div class="row">
<div class="col-md-6">
<div class="servayform">
<label>Name<span style="color:#ff0000;">*</span> </label> <input type="text" placeholder="Write Your Full Name Here...." name="full_name" id="full_name" maxlength='200' required />
</div>
</div>
<div class="col-md-3">
<div class="servayform">
<label>Age<span style="color:#ff0000;">*</span> </label>
<select name="age" id="age" required>
<option value="">Select Age</option>
<option value="1">0 – 18 years old</option>
<option value="2">18 – 30 years old</option>
<option value="3">30 – 45 years old</option>
<option value="4">45 - 60 years old</option>
<option value="5">60+</option>
</select>
<!-- <input type="text" placeholder="Write Here...." name="age" id="age" required />-->
</div>
</div>
<div class="col-md-3">
<div class="servayform">
<label>Gender<span style="color:#ff0000;">*</span> </label>
<select name="gender" id="gender" required>
<option value="">Select</option>
<option value="Male">Male</option>
<option value="Female">Female</option>
<option value="Other">Other</option>
</select>
<!-- <input type="text" placeholder="Write Here...." name="gender" id="gender" />-->
</div>
</div>
<div class="col-md-7">
<div class="servayform">
<label>Address<span style="color:#ff0000;">*</span> </label> <input type="text" placeholder="Write Your Address Here...." name="location" id="location" maxlength='200' required />
</div>
</div>
<div class="col-md-2">
<div class="servayform">
<label>Pincode<span style="color:#ff0000;">*</span> </label> <input type="text" placeholder="Write Your Pincode Here...." name="pincode" id="pincode" onkeyup="this.value=this.value.replace(/[^\d]/,'')" autocomplete="off" maxlength='6' required />
</div>
</div>
<div class="col-md-3">
<div class="servayform">
<label>Contact No.<span style="color:#ff0000;">*</span> </label> <input type="text" placeholder="Write Your Contact No. Here...." name="contact_no" id="contact_no" onkeyup="this.value=this.value.replace(/[^\d]/,'')" autocomplete="off" maxlength="10" required />
</div>
</div>
<div class="col-md-4">
<div class="servayform" style="display:none;">
<label>Date<span style="color:#ff0000;">*</span> </label> <input type="date" placeholder="Write Here...." name="date" value="<?=date('Y-m-d')?>" id="date" maxlength='8' required />
</div>
</div>
<div class="clearfix"></div>
</div>
<ul class="feedback-ul feedback-ulnew1">
<li> <strong>1. Have you heard about Sharda Hospital?<span style="color:#ff0000;">*</span> </strong>
<div class="labels">
<label><input type="radio" value="1" name="answer_one" id="radio_1" onclick="return getsurveydetails('0')" required /> Yes</label>
<label><input type="radio" value="0" name="answer_one" id="radio_1" onclick="return getsurveydetails('1')" required /> No</label>
</div>
</li>
</ul>
<ul class="feedback-ul feedback-ulnew1" id="visited_heard_sharda" style="display:none;">
<li> <strong>2. Have you visited Sharda Hospital?<span style="color:#ff0000;">*</span> </strong>
<div class="labels">
<label><input type="radio" value="1" name="answer_two" id="radio_1_1" onclick="return getsurveyStepdetails('101')" /> Yes</label>
<label><input type="radio" value="0" name="answer_two" id="radio_1_1" onclick="return getsurveyStepdetails('2')" /> No</label>
</div>
</li>
</ul>
<ul class="feedback-ul feedback-ulnew1" id="uhid_heard_sharda" style="display:none;">
<li> <strong>3.Which service did you avail? <span style="color:#ff0000;">*</span></strong>
<div class="labels">
<label><input type="radio" value="1" name="answer_three" id="radio_1_1_2" onclick="return getsurveyStepsdetails('3')" /> IP(Inpatient)</label>
<label><input type="radio" value="2" name="answer_three" id="radio_1_1_2" onclick="return getsurveyStepsdetails('4')" /> OP(Outpatient)</label>
</div>
</li>
</ul>
<ul id="sharda_resp" class="feedback-ulnew"> </ul>
<input type="hidden" name="survey_id" id="survey_id_new" value="" />
<input type="submit" class="button1" name="submit" value="Submit"/>
</form>
</div>
</div>
<script type='text/javascript'>
// baseURL variable
var baseURL= "<?php echo base_url();?>";
function getquestionList(survey_id){
$.ajax({
url:'<?= base_url('survey/getsurveylist') ?>',
method: 'post',
data: {survey_id: survey_id},
dataType: 'json',
success: function(response){
$("#survey_id_new").val(survey_id);
// Add options
//alert(response.response)
$("#sharda_resp").html('');
$("#sharda_resp").html(response.response);
return false;
}
});
}
function openOtherText(ansVal, qid)
{
if(ansVal=='Other'){
$("#other_"+qid).show();
$("#other_ans_"+qid).val('');
} else {
$("#other_"+qid).hide();
$("#other_ans_"+qid).val('');
}
}
function getsurveydetails(survey) {
if(survey=='1'){
// Get Survey
$("#visited_heard_sharda").hide();
let radio = document.getElementById("radio_1_1");
radio.checked = false;
let radion = document.getElementById("radio_1_1_2");
radion.checked = false;
$("#uhid_heard_sharda").hide();
getquestionList(survey);
} else {
$("#sharda_resp").html('');
$("#visited_heard_sharda").show();
}
}
function getsurveyStepdetails(survey) {
if(survey=='101'){
// Get Survey
$("#sharda_resp").html('');
$("#uhid_heard_sharda").show();
} else {
$("#uhid_heard_sharda").hide();
let radio = document.getElementById("radio_1_1_2");
radio.checked = false;
getquestionList(survey);
}
}
function getsurveyStepsdetails(survey) {
if(survey=='3'){
// Get Survey
$("#sharda_resp").html('');
getquestionList(survey);
} else if(survey=='4'){
// Get Survey
$("#sharda_resp").html('');
getquestionList(survey);
}
}
</script>
<button type="button" class="baakbutton" id="btn-back-to-top" >
<i class="fa fa-arrow-up"></i>
</button>
<script>
//Get the button
let mybutton = document.getElementById("btn-back-to-top");
// When the user scrolls down 20px from the top of the document, show the button
window.onscroll = function () {
scrollFunction();
};
function scrollFunction() {
if (
document.body.scrollTop > 200 ||
document.documentElement.scrollTop > 200
) {
mybutton.style.display = "block";
} else {
mybutton.style.display = "none";
}
}
// When the user clicks on the button, scroll to the top of the document
mybutton.addEventListener("click", backToTop);
function backToTop() {
document.body.scrollTop = 0;
document.documentElement.scrollTop = 0;
}
</script>
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