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<style>
label.error, .phonee {
color: red;
font-style: italic;
position: absolute;
top: 13px;
right: 13px;
}
.select {
width: 100%;
height: 40px;
float: left;
padding: 5px;
border: none;
background: #fff;
color: #666;
border-radius: 5px;
font: 12px 'Raleway-SemiBoldItalic';
}
.getEnq form > div > p > input {
width: 100%;
height: 40px;
float: left;
padding: 5px;
border: none;
background: #fff;
border-radius: 5px;
color: #666;
}
.getEnq form > div > p {
width: 100%;
float: left;
margin: 0 0 15px 0;
position: relative;
}
textarea {
width: 100%;
height: 60px;
float: left;
padding: 5px;
resize: none;
border: none;
background: #fff;
border-radius: 5px;
color: #666;
}
.formerror {
color: white;
float: left;
}
</style>
<div class="getEnq sameMnuBox" style="display: none;">
<h2>Get An Enquiry</h2>
<div class="clear"></div>
<span class="drfind_line"></span>
<div class="clear"></div>
<div class="modal-body">
<!-- <div id="successmsg">
<div id="error"></div> -->
<form name="enquiry_form" id="commentFormHeader" >
<h4><span id="successmsg"></span></h4><h4><span id="successmsg1"></span></h4>
<input type="hidden" name="EnquirySource" id="EnquirySource" value="">
<p>
<div class="form-inline row" style="text-align:left;" >
<div class="form-group col-sm-3"><input type="radio" name="EnquiryLocation" id="EnquiryLocation1" onclick="hideB()" value="National" checked/> Indian</div>
<div class="form-group col-sm-4"> <input type="radio" name="EnquiryLocation" id="EnquiryLocation2" onclick="hideA(this.value)" value="International" /> International</div>
<div class="form-group col-sm-3" id='loader2'></div>
</div>
</p>
<!-- new form A-->
<div id="A">
<p>
<input placeholder="Patient Name" name="EnquiryName" id="EnquiryName" type="text">
<span id="nameErr" class="formerror"></span>
</p>
<p>
<input placeholder="Email" name="EnquiryEmail" id="EnquiryEmail" type="text" >
</p>
<p>
<input type="text" style="width:70%;" id="mobile" placeholder="Mobile*" valid="int" maxlength="10" >
<button type="button" class="sentotp" style="background:#069; color:#fff; font-size:20px;width:25%; float:left; margin-left:2%; font-size:14px; padding:7px;" onclick="return sentOtp()" >Send OTP</button>
<span id="contactnoErr" class="formerror"></span>
</p>
<p>
<input type="text" id="otp" placeholder="OTP*" >
<span id="otpErr" class="formerror"></span>
</p>
<p>
<input type="file" name="uploadfile" id="uploadfile" onchange="ValidateSingleInput(this);" >
<span style="float:left">Please upload only pdf,doc,docx,jpg format file upto 3mb size.</span>
</p>
<p>
<textarea placeholder="Enquiry" name="EnquiryMessage" id="EnquiryMessage" ></textarea>
<span id="messageErr" class="formerror"></span>
</p>
<p>
<input name="submit_enquiry" style="background:#069;color:#fff;font-size:20px;" value="submit" type="submit" class="submit" onclick="return submitted()" >
</p>
<!-- <p>
<h4><span id="successmsg"></span></h4>
</p> -->
</div>
<!-- new form B-->
<div style="display:none" id="B">
<p id='scoreshow'> </p>
<p>
<input placeholder="Patient Name" name="EnquiryName1" id="EnquiryName1" type="text">
<span id="nameErr1" class="formerror"></span>
</p>
<p>
<input placeholder="Mobile No" name="mobile1" id="mobile1" type="text" >
</p>
<p>
<input type="text" style="width:70%;" name="EnquiryEmail1" id="EnquiryEmail1" placeholder="Email*" >
<button type="button" class="sentotp1" style="background:#069; color:#fff; font-size:20px;width:25%; float:left; margin-left:2%; font-size:14px; padding:7px;" onclick="return sentOtp1()" >Send OTP</button>
<span id="emailErr1" class="formerror"></span>
</p>
<p>
<input type="text" id="otp1" placeholder="OTP*">
<span id="otpErr1" class="formerror"></span>
</p>
<p>
<input type="file" name="uploadfile1" id="uploadfile1" onchange="ValidateSingleInput(this);">
<span style="float:left">Please upload only pdf,doc,docx,jpg format file upto 3mb size.</span>
</p>
<p>
<textarea placeholder="Enquiry" name="EnquiryMessage1" id="EnquiryMessage1"></textarea>
<span id="messageErr1" class="formerror"></span>
</p>
<p>
<input name="submit_enquiry" style="background:#069;color:#fff;font-size:20px;" value="submit" type="submit" class="submit1" onclick="return submitted1()" >
</p>
<!-- <p>
<h4><span id="successmsg1"></span></h4>
</p> -->
</div>
<!-- <p id='scoreshow'> </p>
<p>
<input placeholder="Patient Name" ng-model="CR.regdata1.EnquiryName" name="EnquiryName" id="EnquiryName" required="" type="text">
</p>
<div id="custom-div">
<p>
<input placeholder="Email" ng-model="CR.regdata1.EnquiryEmail" name="EnquiryEmail" id="EnquiryEmail" required type="text" >
</p>
<p>
<input type="text" class="form-control" style="width:70%;" ng-model="CR.regdata1.mobile" id="mobile" placeholder="Mobile*" valid="int" maxlength="10">
<button type="button" class="sentotp" style="background:#069; color:#fff; font-size:20px;width:25%; float:left; margin-left:2%; font-size:14px; padding:7px;" >Send OTP</button>
</p>
</div>
<p>
<input type="text" class="form-control" id="otp" placeholder="OTP*" ng-model="CR.regdata1.otp">
</p>
<p>
<input type="file" name="uploadfile" id="uploadfile" onchange="ValidateSingleInput(this);" required>
<span>Please upload only pdf,doc,docx format file.</span>
</p>
<p>
<textarea placeholder="Enquiry" ng-model="CR.regdata1.EnquiryMessage" name="EnquiryMessage" id="EnquiryMessage" required> </textarea>
</p>
<p>
<input name="submit_enquiry" style="background:#069;color:#fff;font-size:20px;" value="submit" type="submit" class="submit" >
</p> -->
</form></div>
</div>
<!--form-validation-start-->
<script src="<?php echo base_url();?>assets/js/jquery.validate.js"></script>
<script>
$.validator.setDefaults({
submitHandler: function() {
$("#commentFormHeader").submit();
//alert("submitted!");
}
});
$().ready(function() {
// validate the comment form when it is submitted
$("#commentFormHeader").validate();
// validate signup form on keyup and submit
$("#signupForm").validate({
rules: {
firstname: "required",
lastname: "required",
username: {
required: true,
minlength: 2
},
password: {
required: true,
minlength: 5
},
confirm_password: {
required: true,
minlength: 5,
equalTo: "#password"
},
email: {
required: true,
email: true
},
topic: {
required: "#newsletter:checked",
minlength: 2
},
agree: "required"
},
messages: {
firstname: "Please enter your firstname",
lastname: "Please enter your lastname",
username: {
required: "Please enter a username",
minlength: "Your username must consist of at least 2 characters"
},
password: {
required: "Please provide a password",
minlength: "Your password must be at least 5 characters long"
},
confirm_password: {
required: "Please provide a password",
minlength: "Your password must be at least 5 characters long",
equalTo: "Please enter the same password as above"
},
email: "Please enter a valid email address",
agree: "Please accept our policy",
topic: "Please select at least 2 topics"
}
});
// propose username by combining first- and lastname
$("#username").focus(function() {
var firstname = $("#firstname").val();
var lastname = $("#lastname").val();
if (firstname && lastname && !this.value) {
this.value = firstname + "." + lastname;
}
});
//code to hide topic selection, disable for demo
var newsletter = $("#newsletter");
// newsletter topics are optional, hide at first
var inital = newsletter.is(":checked");
var topics = $("#newsletter_topics")[inital ? "removeClass" : "addClass"]("gray");
var topicInputs = topics.find("input").attr("disabled", !inital);
// show when newsletter is checked
newsletter.click(function() {
topics[this.checked ? "removeClass" : "addClass"]("gray");
topicInputs.attr("disabled", !this.checked);
});
});
//mobile
$(document).ready(function() {
$('#ContactPhone').blur(function(e) {
if (validatePhone('ContactPhone')) {
$('#spnPhoneStatus').html('Valid');
$('#spnPhoneStatus').css('color', 'green');
}
else {
$('#spnPhoneStatus').html('Invalid');
$('#spnPhoneStatus').css('color', 'red');
}
});
});
function validatePhone(ContactPhone) {
var a = document.getElementById(ContactPhone).value;
var filter = /^((\+[1-9]{1,4}[ \-]*)|(\([0-9]{2,3}\)[ \-]*)|([0-9]{2,4})[ \-]*)*?[0-9]{3,4}?[ \-]*[0-9]{3,4}?$/;
if (filter.test(a)) {
return true;
}
else {
return false;
}
}
// function Getlocation(sid){
// var getlocat = 'getvalue='+sid;
// console.log(getlocat);
// $.ajax({
// type: "POST",
// dataType: 'html',
// data: getlocat,
// url: 'Enquiry/Countrylist',
// beforeSend: function(){
// // Show image container
// $("#loader2").html("<img src='<?php echo base_url();?>images/ajax-loader.gif' width='25px;'>");
// },
// success: function(data) {
// $('#scoreshow').html(data);
// $('#loader2').hide();
// if(getlocat == "getvalue=National"){
// str = '<p><input placeholder="Email" ng-model="CR.regdata.EnquiryEmail" name="EnquiryEmail" id="EnquiryEmail" required type="text" ></p><p><input type="text" class="form-control" style="width:70%;" id="mobile" ng-model="CR.regdata.mobile" placeholder="Mobile*" valid="int" maxlength="10"><button type="button" class="sentotp" style="background:#069; color:#fff; font-size:20px;width:25%; float:left; margin-left:2%; font-size:14px; padding:7px;" >Send OTP</button></p>';
// } else {
// str = '<p><input placeholder="Mobile Number" ng-model="CR.regdata.mobile" name="Enquirymobile" id="mobile" required type="text" ></p><p><input type="text" class="form-control" style="width:70%; float:left" id="EnquiryEmail" ng-model="CR.regdata.EnquiryEmail" placeholder="Email*"><button type="button" class="sentotp" style="background:#069; color:#fff; font-size:20px;width:25%; float:left; margin-left:2%; font-size:14px; padding:7px;" >Send OTP</button></p>';
// }
// $('#custom-div').html('');
// $('#custom-div').html(str);
// }
// });
// }
function hideA(sid)
{
// document.getElementById("A").style.visibility="hidden";
// document.getElementById("B").style.visibility="visible";
var getlocat = 'getvalue='+sid;
$.ajax({
type: "POST",
dataType: 'html',
data: getlocat,
url: '<?php echo base_url("Enquiry/Countrylist");?>',
beforeSend: function(){
// Show image container
$("#loader2").html("<img src='<?php echo base_url();?>images/ajax-loader.gif' width='50px;'>");
},
success: function(data) {
$('#scoreshow').html(data);
$('#loader2').hide();
$('#A').hide();
$('#B').show();
$("#commentFormHeader").find('input:text, textarea').val('');
$('.formerror').html('');
// if(getlocat == "getvalue=National"){
// str = '<p><input placeholder="Email" ng-model="CR.regdata.EnquiryEmail" name="EnquiryEmail" id="EnquiryEmail" required type="text" ></p><p><input type="text" class="form-control" style="width:70%;" id="mobile" ng-model="CR.regdata.mobile" placeholder="Mobile*" valid="int" maxlength="10"><button type="button" class="sentotp" style="background:#069; color:#fff; font-size:20px;width:25%; float:left; margin-left:2%; font-size:14px; padding:7px;" >Send OTP</button></p>';
// } else {
// str = '<p><input placeholder="Mobile Number" ng-model="CR.regdata.mobile" name="Enquirymobile" id="mobile" required type="text" ></p><p><input type="text" class="form-control" style="width:70%; float:left" id="EnquiryEmail" ng-model="CR.regdata.EnquiryEmail" placeholder="Email*"><button type="button" class="sentotp" style="background:#069; color:#fff; font-size:20px;width:25%; float:left; margin-left:2%; font-size:14px; padding:7px;" >Send OTP</button></p>';
// }
// $('#custom-div').html('');
// $('#custom-div').html(str);
}
});
}
function hideB()
{
$('#B').hide();
$('#A').show();
$("#commentFormHeader").find('input:text, textarea').val('');
$('.formerror').html('');
// document.getElementById("B").style.visibility="hidden";
// document.getElementById("A").style.visibility="visible";
}
/*************************upload file ***************/
var _validFileExtensions = [".pdf", ".doc", ".docx", ".xls", ".txt",".jpg"];
function ValidateSingleInput(oInput) {
if (oInput.type == "file") {
var sFileName = oInput.value;
if (sFileName.length > 0) {
var blnValid = false;
for (var j = 0; j < _validFileExtensions.length; j++) {
var fsize = _validFileExtensions[j].size;
var file = Math.round((fsize / 1024));
// The size of the file.
if (file >= 3072) {
alert(
"File too Big, please select a file less than 3mb");
}
var sCurExtension = _validFileExtensions[j];
if (sFileName.substr(sFileName.length - sCurExtension.length, sCurExtension.length).toLowerCase() == sCurExtension.toLowerCase()) {
blnValid = true;
break;
}
}
if (!blnValid) {
alert("Sorry, " + sFileName + " is invalid. Allowed extensions are: " + _validFileExtensions.join(", "));
oInput.value = "";
return false;
}
}
}
return true;
}
function clearerrors(){
errors = document.getElementsByClassName('formerror');
for(error of errors)
{
error.innerHTML = "";
}
}
function sentOtp(){
var returnval = true;
clearerrors();
var EnquiryName = document.getElementById("EnquiryName").value;
var EnquiryEmail = document.getElementById("EnquiryEmail").value;
var mobile = document.getElementById("mobile").value;
var EnquiryMessage = document.getElementById("EnquiryMessage").value;
//name validation
var alphaExp = /^[^-\s][a-zA-Z ]{2,30}$/;
if(!EnquiryName.match(alphaExp)){
document.getElementById('nameErr').innerText = "Only alphabets are allowed";
returnval = false;
}
if(EnquiryName == ""){
document.getElementById('nameErr').innerText = "*Patient Name is required.";
returnval = false;
}
//contactno validation
if(mobile.length != 10){
document.getElementById('contactnoErr').innerText = "Mobile number must be of ten digits";
returnval= false;
}
var phoneExp = /^[^-\s][0-9]+$/;
if(!mobile.match(phoneExp)){
document.getElementById('contactnoErr').innerText = "Only numbers are allowed ";
returnval= false;
}
if(mobile == ""){
document.getElementById('contactnoErr').innerText = "*Mobile No. is required.";
returnval = false;
}
if(returnval == true){
$.ajax({
url: "<?php echo base_url();?>lms/api/Enquiry/sent_otp_enquiry",
type: 'POST',
data: {EnquiryName: EnquiryName , EnquiryEmail: EnquiryEmail , mobile: mobile , EnquiryMessage: EnquiryMessage },
error: function() {
alert('Something is wrong');
},
success: function(data) {
// console.log(data);
$('#successmsg').fadeIn().html("OTP sent successfully!!!");
setTimeout(function() {
$('#successmsg').fadeOut(9000);
}, 2000 );
// $("#successmsg").html("OTP sent successfully");
}
});
}
}
function submitted(){
var returnval = true;
clearerrors();
var EnquiryName = document.getElementById("EnquiryName").value;
var EnquiryEmail = document.getElementById("EnquiryEmail").value;
var mobile = document.getElementById("mobile").value;
var otp = document.getElementById("otp").value;
var EnquiryMessage = document.getElementById("EnquiryMessage").value;
//name validation
var alphaExp = /^[^-\s][a-zA-Z ]{2,30}$/;
if(!EnquiryName.match(alphaExp)){
document.getElementById('nameErr').innerText = "Only alphabets are allowed";
returnval = false;
}
if(EnquiryName == ""){
document.getElementById('nameErr').innerText = "*Patient Name is required.";
returnval = false;
}
//contactno validation
if(mobile.length != 10){
document.getElementById('contactnoErr').innerText = "Mobile number must be of ten digits";
returnval= false;
}
var phoneExp = /^[^-\s][0-9]+$/;
if(!mobile.match(phoneExp)){
document.getElementById('contactnoErr').innerText = "Only numbers are allowed ";
returnval= false;
}
if(mobile == ""){
document.getElementById('contactnoErr').innerText = "*Mobile No. is required.";
returnval = false;
}
//otp validation
if(otp == ""){
document.getElementById('otpErr').innerText = "*OTP is required.";
returnval = false;
}
//message validation
var msgExp = /^[^-\s][a-zA-Z]/ ;
if(!EnquiryMessage.match(msgExp)){
document.getElementById('messageErr').innerText = "*Message is required.";
returnval = false;
}
if(EnquiryMessage == ""){
document.getElementById('messageErr').innerText = "*Message is required.";
returnval = false;
}
if(returnval == true){
$.ajax({
url: "<?php echo base_url();?>lms/api/Enquiry/enquiry",
type: 'POST',
data: {EnquiryName: EnquiryName ,
EnquiryEmail: EnquiryEmail ,
mobile: mobile ,
otp : otp,
EnquiryMessage: EnquiryMessage },
error: function() {
alert('Something is wrong');
},
success: function(data) {
// console.log(data);
// if(data == "Invalid OTP"){
$("#commentFormHeader").find('input:text, textarea').val('');
$('#successmsg').fadeIn().html(data);
setTimeout(function() {
$('#successmsg').fadeOut(9000);
}, 2000 );
// } else{
// $("#commentFormHeader").find('input:text, textarea').val('');
// $('#successmsg').fadeIn().html("Thanks for contacting us!!!");
// setTimeout(function() {
// $('#successmsg').fadeOut(9000);
// }, 2000 );
// }
}
});
}
}
function sentOtp1(){
var returnval = true;
clearerrors();
var EnquiryName1 = document.getElementById("EnquiryName1").value;
var EnquiryEmail1 = document.getElementById("EnquiryEmail1").value;
var mobile1 = document.getElementById("mobile1").value;
var EnquiryMessage1 = document.getElementById("EnquiryMessage1").value;
//name validation
var alphaExp = /^[^-\s][a-zA-Z ]{2,30}$/;
if(!EnquiryName1.match(alphaExp)){
document.getElementById('nameErr1').innerText = "Only alphabets are allowed";
returnval = false;
}
if(EnquiryName1 == ""){
document.getElementById('nameErr1').innerText = "*Patient Name is required.";
returnval = false;
}
//email validation
var emailexp = /^(([a-zA-Z0-9_\-\.]+)@([a-zA-Z0-9_\-\.]+)\.([a-zA-Z]{2,5}){1,25})+([;.](([a-zA-Z0-9_\-\.]+)@{[a-zA-Z0-9_\-\.]+0\.([a-zA-Z]{2,5}){1,25})+)*$/;
if(!EnquiryEmail1.match(emailexp)){
document.getElementById('emailErr1').innerText = "Email Id is Invalid";
returnval =false;
}
if(EnquiryEmail1 == ""){
document.getElementById('emailErr1').innerText = "*Email Id is required.";
returnval = false;
}
if(returnval == true){
$.ajax({
url: "<?php echo base_url();?>lms/api/Enquiry/sent_otp_enquiry1",
type: 'POST',
data: {EnquiryName1: EnquiryName1 , EnquiryEmail1: EnquiryEmail1 , mobile1: mobile1 , EnquiryMessage1: EnquiryMessage1 },
error: function() {
alert('Something is wrong');
},
success: function(data) {
// console.log(data);
$('#successmsg1').fadeIn().html("OTP sent successfully!!!");
setTimeout(function() {
$('#successmsg1').fadeOut(9000);
}, 2000 );
}
});
}
}
function submitted1(){
var returnval = true;
clearerrors();
var EnquiryName1 = document.getElementById("EnquiryName1").value;
var EnquiryEmail1 = document.getElementById("EnquiryEmail1").value;
var mobile1 = document.getElementById("mobile1").value;
var otp1 = document.getElementById("otp1").value;
var EnquiryMessage1 = document.getElementById("EnquiryMessage1").value;
//name validation
var alphaExp = /^[^-\s][a-zA-Z ]{2,30}$/;
if(!EnquiryName1.match(alphaExp)){
document.getElementById('nameErr1').innerText = "Only alphabets are allowed";
returnval = false;
}
if(EnquiryName1 == ""){
document.getElementById('nameErr1').innerText = "*Patient Name is required.";
returnval = false;
}
//email validation
var emailexp = /^(([a-zA-Z0-9_\-\.]+)@([a-zA-Z0-9_\-\.]+)\.([a-zA-Z]{2,5}){1,25})+([;.](([a-zA-Z0-9_\-\.]+)@{[a-zA-Z0-9_\-\.]+0\.([a-zA-Z]{2,5}){1,25})+)*$/;
if(!EnquiryEmail1.match(emailexp)){
document.getElementById('emailErr1').innerText = "Email Id is Invalid";
returnval =false;
}
if(EnquiryEmail1 == ""){
document.getElementById('emailErr1').innerText = "*Email Id is required.";
returnval = false;
}
//otp validation
if(otp1 == ""){
document.getElementById('otpErr1').innerText = "*OTP is required.";
returnval = false;
}
//message validation
var msgExp = /^[^-\s][a-zA-Z]/ ;
if(!EnquiryMessage1.match(msgExp)){
document.getElementById('messageErr1').innerText = "*Message is required.";
returnval = false;
}
if(EnquiryMessage1 == ""){
document.getElementById('messageErr1').innerText = "*Message is required.";
returnval = false;
}
if(returnval == true){
$.ajax({
url: "<?php echo base_url();?>lms/api/Enquiry/enquiry1",
type: 'POST',
data: {EnquiryName1: EnquiryName1 ,
EnquiryEmail1: EnquiryEmail1 ,
mobile1: mobile1 ,
otp1 : otp1 ,
EnquiryMessage1: EnquiryMessage1 },
error: function() {
alert('Something is wrong');
},
success: function(data) {
// console.log(data);
$("#commentFormHeader").find('input:text, textarea').val('');
$('#successmsg1').fadeIn().html(data);
setTimeout(function() {
$('#successmsg1').fadeOut(9000);
}, 2000 );
}
});
}
}
/****************** END ********************/
</script>
<!--form-validation-end-->
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