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<style>
/*form*/
label.error, .phonee {
color: red;
font-style: italic;
position: absolute;
top: 13px;
right: 13px;
}
.select {
width: 527%;
height: 40px;
float: left;
padding: 5px;
border: none;
background: #fff;
color: #666;
border-radius: 5px;
font: 12px 'Raleway-SemiBoldItalic';
}
</style>
<div class="makeApp sameMnuBox" style="display: none;">
<button type="button" class="close" id="close-appointment"><span aria-hidden="true">×</span></button>
<h2>Book an Appointment</h2>
<div class="clear"></div>
<span class="drfind_line"></span>
<div class="clear"></div>
<div class="row">
<form id="regForm" class="form" autocomplete="off" spellcheck="false">
<div class="col-md-12">
<div class="modal-body">
<p>
<input type="text" class="form-control" ng-model="CR.regdata.name" placeholder="Name*">
</p
><p>
<input type="text" class="form-control" ng-model="CR.regdata.email" placeholder="Email ID*">
</p>
<p>
<select class="form-control" ng-model="CR.regdata.state_id" ng-change="CR.get_cities(CR.regdata.state_id)">
<option value="">Select State*</option>
<option value="{{r.id}}" ng-repeat="r in CR.states">{{r.title}}</option>
</select>
</p>
<p>
<select class="form-control" ng-model="CR.regdata.city_id">
<option value="">Select City*</option>
<option value="{{r.id}}" ng-repeat="r in CR.cities">{{r.title}}</option>
</select>
</p>
<p ng-show="!CR.def_prg_id">
<select class="form-control" ng-model="CR.regdata.program_id">
<option value="">Select Center of Excellence*</option>
<option value="{{r.id}}" ng-repeat="r in CR.programs">{{r.title}}</option>
</select>
</p>
<p>
<input type="text" class="form-control hasCal" ng-model="CR.regdata.appointment_date" placeholder="Preferred Date*">
</p>
<p>
<select class="form-control" ng-model="CR.regdata.appointment_time">
<option value="">Preferred Time*</option>
<option ng-repeat="t in CR.appointment_times">{{t}}</option>
</select>
<p>
<p>
<input type="text" class="form-control" style="width:70%; float:left" ng-model="CR.regdata.mob" placeholder="Mobile*" valid="int" maxlength="10"> <button type="button" class="submit" style="background:#069; color:#fff; font-size:20px;width:25%; float:left; margin-left:2%; font-size:14px; padding:7px;" ng-click="CR.sent_otp()">Send OTP</button>
</p><br /><br /><br />
<p>
<input type="text" class="form-control" placeholder="OTP*" ng-model="CR.regdata.otp">
</p>
<p class="text-center"><button type="button" class="btn btn-primary" ng-click="CR.submit_reg()">Submit ></button></p>
</form>
</div>
<script>
$("#close-appointment").click(function(){
$(".makeApp.sameMnuBox").hide();
});
</script>
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