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Toks Law
2023-01-23 20:44:12 -05:00
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components/Common/AppointmentFormTwo.js
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import React from 'react';
const AppointmentFormTwo = () => {
return (
<div className="appointment-area-three">
<div className="container-fluid p-0">
<div className="row m-0">
<div className="col-lg-7">
<div className="appointment-item appointment-item-two">
<h2>Book your appointment</h2>
<span>We will confirm your appointment within 2 hours</span>
<div className="appointment-form">
<form>
<div className="row">
<div className="col-lg-6">
<div className="form-group">
<i className="icofont-business-man-alt-1"></i>
<label>Name</label>
<input type="text" className="form-control" placeholder="Enter Your Name" />
</div>
</div>
<div className="col-lg-6">
<div className="form-group">
<i className="icofont-ui-message"></i>
<label>Email</label>
<input type="email" className="form-control" placeholder="Enter Your Email" />
</div>
</div>
<div className="col-lg-6">
<div className="form-group">
<i className="icofont-ui-call"></i>
<label>Phone</label>
<input type="text" className="form-control" placeholder="Enter Your Number" />
</div>
</div>
<div className="col-lg-6">
<div className="form-group">
<i className="icofont-hospital"></i>
<label>Services</label>
<select className="form-control" id="exampleFormControlSelect1">
<option>Dental Care</option>
<option>Pathology</option>
<option>Diagnosis</option>
<option>Neurology</option>
<option>Cardiology</option>
</select>
</div>
</div>
<div className="col-lg-6">
<div className="form-group">
<i className="icofont-doctor"></i>
<label>Doctor</label>
<input type="text" className="form-control" placeholder="Choose Your Doctor" />
</div>
</div>
<div className="col-lg-6">
<div className="form-group">
<i className="icofont-business-man"></i>
<label>Age</label>
<input type="text" className="form-control" placeholder="Your Age" />
</div>
</div>
</div>
<div className="text-center">
<button type="submit" className="btn appointment-btn">Submit</button>
</div>
</form>
</div>
</div>
</div>
<div className="col-lg-5 pr-0">
<div className="speciality-item speciality-right speciality-right-two speciality-right-three">
<img src="/images/doctors/doctor4.jpg" alt="Doctor" />
<div className="speciality-emergency">
<div className="speciality-icon">
<i className="icofont-ui-call"></i>
</div>
<h3>Emergency Call</h3>
<p>+07 554 332 322</p>
</div>
</div>
</div>
</div>
</div>
</div>
)
}
export default AppointmentFormTwo;