ikan Uploader :
Directory : /var/www/html/shardahospital_old.org/hbackup/application/views/includes/
Upload File : |
| Current File : /var/www/html/shardahospital_old.org/hbackup/application/views/includes/blog_book_appointment.php |
<?php error_reporting(0);?>
<div class="modal fade" id="makeAnAppointment" tabindex="-1" role="dialog" aria-labelledby="exampleModalCenterTitle" aria-hidden="true">
<div class="modal-dialog modal-dialog-centered" role="document">
<div class="modal-content">
<div class="modal-header">
<h2 class="modal-title text-md-center" id="exampleModalCenterTitle">Book an Appointment</h2>
</div>
<div class="clearfix"></div>
<div class="modal-body">
<h4 class="res_special2" style="text-align:center"> </h4>
<form name="enquiry_form" method="POST" accept-charset="utf-8" id="appointment">
<div class="col-md-12 float-none mx-auto">
<div class="form-group">
<input type="text" class="form-control" name="RequestPatientName" id="RequestPatientName" placeholder="Patient Name" required>
</div>
<div class="form-group">
<input type="text" class="form-control" name="RequestPatientMobile" id="RequestPatientMobile" placeholder="Mobile No." maxlength="10" required>
<span id='errmsg' style="color:#900; font-size:12px;"> </span>
</div>
<div class="form-group">
<input placeholder="Email Id." name="RequestPatientEmail" id="RequestPatientEmail" autocomplete="off" type="text" maxlength="80">
<span class="email" id="spnEmailStatus"></span>
</div>
<div class="form-group">
<select class="form-control" id="RequestDepartment" name="RequestDepartment" required>
<option value="">Choose Speciality</option>
<?php foreach($departments_list as $dep){
echo '<option value="'.$dep['DepartmentID'].'">'.$dep['DepartmentName'].'</option>';
} ?>
</select>
</div>
</div>
<div class="clearfix"></div>
</div>
<div class="modal-footer">
<button type="button" class="btn btn-secondary" data-dismiss="modal">Close</button>
<input type="submit" name="submit_enquiry" id="submit_enquiry" class="btn btn-primary" value="submit" />
</div>
</form>
</div>
</div>
</div>
<script src="<?php echo base_url();?>assets/blog/js/jquery.min.js"></script>
<script typ="text/javascript">
$("#RequestPatientMobile").keypress(function (e) {
if (e.which != 8 && e.which != 0 && (e.which < 48 || e.which > 57)) {
//display error message
$("#errmsg").html("<strong>Enter Number Only</strong>").show().fadeOut("slow");
return false;
}
});
$('#submit_enquiry').click(function(event) {
event.preventDefault();
var RequestPatientName = $("#RequestPatientName").val();
var RequestPatientMobile = $("#RequestPatientMobile").val();
var RequestDepartment = $("#RequestDepartment").val();
var urlnew = '<?php echo $ses;?>';
if(urlnew){
var dataString = 'RequestPatientName='+RequestPatientName+'&RequestPatientMobile='+RequestPatientMobile+'&RequestDepartment='+RequestDepartment+'&urlnew='+urlnew;
} else {
var dataString = 'RequestPatientName='+RequestPatientName+'&RequestPatientMobile='+RequestPatientMobile+'&RequestDepartment='+RequestDepartment;
}
$.ajax({
type: "POST",
dataType: "html",
url: "<?php echo base_url();?>book_apk",
data: dataString,
'contentType': "application/x-www-form-urlencoded; charset=UTF-8",
cache: false,
beforeSend: function() {
$('#res3').html('Please Wait');
},
success: function(data) {
//$('.res_special').html(data);
$('.res_special2').fadeIn().html(data);
}
});
});
</script>
Kontol Shell Bypass