84 lines
4.3 KiB
JavaScript
Executable File
84 lines
4.3 KiB
JavaScript
Executable File
import React from 'react';
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const AppointmentForm = () => {
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return (
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<div className="appointment-area ptb-100 plr-15">
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<div className="container-fluid p-0">
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<div className="appointment-item">
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<h2>Book your appointment</h2>
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<span>We will confirm your appointment within 2 hours</span>
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<div className="appointment-form">
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<form>
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<div className="row">
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<div className="col-lg-6">
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<div className="form-group">
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<i className="icofont-business-man-alt-1"></i>
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<label>Name</label>
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<input type="text" className="form-control" placeholder="Enter Your Name" />
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</div>
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</div>
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<div className="col-lg-6">
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<div className="form-group">
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<i className="icofont-ui-message"></i>
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<label>Email</label>
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<input type="email" className="form-control" placeholder="Enter Your Email" />
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</div>
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</div>
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<div className="col-lg-6">
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<div className="form-group">
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<i className="icofont-ui-call"></i>
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<label>Phone</label>
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<input type="text" className="form-control" placeholder="Enter Your Number" />
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</div>
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</div>
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<div className="col-lg-6">
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<div className="form-group">
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<i className="icofont-hospital"></i>
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<label>Services</label>
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<select className="form-control" id="exampleFormControlSelect1">
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<option>Dental Care</option>
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<option>Neurology</option>
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<option>Cardiology</option>
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<option>Pathology</option>
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</select>
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</div>
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</div>
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<div className="col-lg-6">
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<div className="form-group">
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<i className="icofont-doctor"></i>
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<label>Doctor</label>
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<select className="form-control" id="exampleFormControlSelect2">
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<option>Choose Your Doctor</option>
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<option>John Smith</option>
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<option>Sarah Taylor</option>
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<option>Stevn King</option>
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</select>
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</div>
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</div>
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<div className="col-lg-6">
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<div className="form-group">
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<i className="icofont-business-man"></i>
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<label>Age</label>
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<input type="text" className="form-control" placeholder="Your Age" />
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</div>
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</div>
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</div>
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<div className="text-center">
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<button type="submit" className="btn appointment-btn">Submit</button>
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</div>
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</form>
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</div>
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</div>
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</div>
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</div>
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)
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}
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export default AppointmentForm; |