Online-Medical-Store/Consult.html at main · Abishek-Newar/Online-Medical-Store · GitHub

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<!DOCTYPE html>
<html lang="en">

    <head>
        <meta charset="UTF-8">
        <meta name="viewport" contents="width=device-width, initial-scale=1.0">
        <meta http-equiv="X-UA-Compatible" content="ie=edge">
        <meta name="Description" content="Enter your description here" />
        <title>Contact Us | Medicare</title>
        <link href="https://cdn.jsdelivr.net/npm/bootstrap@5.1.3/dist/css/bootstrap.min.css" rel="stylesheet" >
        <link rel="stylesheet" href="https://cdnjs.cloudflare.com/ajax/libs/font-awesome/6.0.0/css/all.min.css">
        <link rel="stylesheet" href="css/project.css">
        <link rel="stylesheet" href="css/responsive-style.css">
    </head>
    <body>
        <header>
            <nav class="navbar navbar-expand-lg navigation-wrap" >
                <div class="container" >
                    <a class="navbar-brand" href="#"><img src="Logo/Minimalist Hospital and Medical Health Logo.png" width="100" height="60"></a>
                    <button class="navbar-toggler" type="button" data-bs-toggle="collapse" data-bs-target="#navbarText"
                    aria-controls="navbarText" aria-expanded="false" aria-label="Toggle navigation">
                    <i class="fas fa-stream navbar-toggler-icon"></i>
                </button>
                <div class="collapse navbar-collapse" id="navbarText">
                    <ul class="navbar-nav ms-auto mb-2 mb-lg-0">
                        <li class="nav-item">
                            <a class="nav-link active" aria-current="page" href="index.html">Home</a>
                        </li>
                    </ul>
                </div>
                </div>
            </nav>
        </header>
    <section id="contact">
        <h1 class="h-primary center">Add Details</h1>
        <h3 class="h-secondary center">For Consultance</h3>
        <div id="contact-box">
            <form action="consult.php" method="post">
                <div class="form-group">
                    <label for="name">Name: </label>
                    <input type="text" name="name" id="name" placeholder="Enter your name">
                </div>
                <div class="form-group">
                    <label for="email">Email: </label>
                    <input type="email" name="email" id="email" placeholder="Enter your email">
                </div>
                <div class="form-group">
                    <label for="phone">Phone Number: </label>
                    <input type="phone" name="phone" id="phone" placeholder="Enter your phone">
                </div>
                <div class="form-group">
                    <label for="address">Address: </label>
                    <textarea name="address" id="address" cols="30" rows="10"></textarea>
                </div>
                <div class="form-group">
                    <label for="name">Doctor Name: </label>
                    <input type="text" name="doctorname" id="doctorname" placeholder="Enter your name">
                </div>
            <button class="bt" name="save">Submit</button>
            </form>
        </div>

    </section>

    <footer id="footer">
        <div class="footer py-5">
          <div class="container">
              <div class="row">
                  <div class="col-md-12 text-center">
              <div class="footer-social pt-4 text-center">
                <a href="https://www.facebook.com/"><i class="fab fa-facebook-f"></i></a>
                <a href="https://twitter.com/"><i class="fab fa-twitter"></i></a>
                <a href="https://www.youtube.com/"><i class="fab fa-youtube"></i></a>
                <a href="https://www.instagram.com/"><i class="fab fa-instagram"></i></a>
                  </div>
              </div>
              <div class="col-sm-12">
                  <div class="footer-copy">
                    <div class="copy-right text-center pt-5">
                      <p class="text-light">© 2022. Hungers. All rights reserved.</p>
                    </div>
                  </div>
          </div>
        </div>
    </footer>
    <script src="https://cdn.jsdelivr.net/npm/@popperjs/core@2.10.2/dist/umd/popper.min.js"></script>
        <script src="https://cdn.jsdelivr.net/npm/bootstrap@5.1.3/dist/js/bootstrap.min.js"></script>
        <script src="js/main.js"></script>
</body>

</html>