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book-appointment.html
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book-appointment.html
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<!DOCTYPE html>
<html lang="en">
<head>
<meta charset="UTF-8">
<meta http-equiv="X-UA-Compatible" content="IE=edge">
<meta name="viewport" content="width=device-width, initial-scale=1.0">
<title>Carenow – Medical & Dentist HTML Tempate</title>
<link rel="stylesheet" href="assets/css/color/color-1.css">
<link rel="stylesheet" href="assets/css/style.css">
<!--animation-->
<link rel="stylesheet" href="assets/animation/animate.css">
<link rel="stylesheet" href="assets/css/responsive.css">
<!--logo-->
<link rel="icon" href="assets/image/Facvicon.png" sizes="32x32" />
</head>
<body class="header_sticky">
<!-- Preloader -->
<div id="loading-overlay">
<div class="loader"></div>
</div>
<div class="wrapper">
<div id="page">
<header class="header clearfix">
<div id="header">
<div id="site-header">
<div class="logo">
<a href="index.html">
<img src="assets/image/LogoDark.png" alt="image">
</a>
</div>
<!-- //mobile menu button -->
<div class="nav-wrap">
<nav id="mainnav" class="mainnav">
<ul class="menu">
<li class="menu-item-has-children">
<a href="index.html" title="">Home</a>
<ul class="sub-menu">
<li><a href="index.html" title="">Home 01</a></li>
<li><a href="home2.html" title="">Home 02</a></li>
</ul>
<!-- /.sub-menu -->
</li>
<li class="menu-item-has-children">
<a href="about-us.html" title="">About Us</a>
<ul class="sub-menu">
<li><a href="about-us.html" title="">About</a></li>
<li><a href="doctor.html" title="">Doctor</a></li>
<li><a href="doctor-details.html" title="">Doctor Details</a></li>
<li><a href="pricing-table.html" title="">Our Pricing</a></li>
<li><a href="gallery.html" title="">Gallery</a></li>
<li><a href="faq.html" title="">FAQ</a></li>
</ul>
<!-- /.sub-menu -->
</li>
<li class="menu-item-has-children">
<a href="services.html" title="">Services</a>
<ul class="sub-menu">
<li><a href="services.html" title="">Services</a></li>
<li><a href="service-details.html" title="">Services Details</a></li>
</ul>
<!-- /.sub-menu -->
</li>
<li class="menu-item-has-children">
<a href="blog-standard.html" title="">Blog</a>
<ul class="sub-menu">
<li><a href="blog-standard.html" title="">Blog Standard</a></li>
<li><a href="blog-details.html" title="">Blog Details</a></li>
</ul>
<!-- /.sub-menu -->
</li>
<li class="active">
<a href="book-appointment.html" title="">Book Appointment</a>
</li>
<li>
<a href="contact.html" title="">Contact</a>
</li>
</ul>
<!-- /.menu -->
</nav>
</div>
<!-- /#mainnav -->
<div class="contact">
<div class="top-bar-right">
<div class="call-us">
<div class="icon-call-us"></div>
<div class="content-call-us">
<p>Call Us</p>
<a href="tel:360-779-2228" class="font-bold text-color-title-sidebar">360-779-2228</a>
</div>
</div>
<div class="button-header">
<a href="book-appointment.html" class="themesflat-button bg-accent btn-header"><span>Get Appointment</span></a>
</div>
</div>
</div>
<div class="btn-menu">
<span></span>
</div>
</div>
</div>
</header>
<div id="header-baner">
<div class="container">
<div class="text-banner wow fadeInDown">
<div class="baner-tittle">
Book Appointment
</div>
<div class="baner-content">
<a href="index.html" class="font-raguler">Home </a><span> | Book Appointment
</span>
</div>
</div>
</div>
</div>
<!-- Main Content -->
<div id="main-content" class="site-main clearfix">
<div id="content-wrap">
<div id="site-content" class="site-content clearfix">
<div id="inner-content" class="inner-content-wrap">
<div class="page-content">
<div class="container">
<div class="row">
<div class="themesflat-spacer clearfix" data-desktop="120" data-mobile="70" data-smobile="70"></div>
</div>
<div class="row">
<div class="col-lg-8 col-md-12 col-sm-12">
<div class="your-information">
<div class="themesflat-spacer clearfix" data-desktop="63" data-mobile="63" data-smobile="63"></div>
<h4 class="text-color-title-sidebar wow fadeInDown">
Your Information:
</h4>
<div class="themesflat-spacer clearfix" data-desktop="27" data-mobile="27" data-smobile="27"></div>
<div class="form-your-info">
<form action="#">
<div class="row-info wow fadeInDown">
<div class="col-info-6">
<input type="text" placeholder="Patient name">
<span class="icon-form">
<i class="fas fa-user-edit"></i>
</span>
</div>
<div class="col-info-6">
<input type="text" placeholder="Email">
<span class="icon-form">
<i class="fas fa-at"></i>
</span>
</div>
</div>
<div class="row-info wow fadeInDown">
<div class="col-info-6 focus-date">
<input type="text" placeholder="Date of Birth" onfocus="(this.type='date')">
<span class="icon-form">
<i class="far fa-calendar-alt"></i>
</span>
</div>
<div class="col-info-6">
<input type="text" placeholder="Mobile Number">
<span class="icon-form">
<i class="fas fa-phone-alt"></i>
</span>
</div>
</div>
<div class="themesflat-spacer clearfix" data-desktop="15" data-mobile="15" data-smobile="15"></div>
<div class="row-info wow fadeInDown">
<div class="col-info-12">
<div class="box-gender">
<div class="title-gender">
Gender :
</div>
<div class="list-gender">
<div class="option-gender">
<input type="radio" name="gender" value="1" checked="checked">
<span class="check-custom"></span>
<label class="text-color-title-sidebar">Male</label>
</div>
<div class="option-gender">
<input type="radio" name="gender" value="2">
<span class="check-custom"></span>
<label class="text-color-title-sidebar">Female</label>
</div>
</div>
</div>
</div>
</div>
<div class="themesflat-spacer clearfix" data-desktop="35" data-mobile="35" data-smobile="35"></div>
<div class="row-info wow fadeInDown">
<div class="col-info-12 icon-down">
<span class="icon-form">
<i class="fas fa-chevron-down"></i>
</span>
<select name="hospital">
<option value="1">Select Hospital</option>
<option value="2">Select Hospital</option>
<option value="3">Select Hospital</option>
</select>
</div>
</div>
<div class="row-info wow fadeInDown">
<div class="col-info-12 icon-down">
<span class="icon-form">
<i class="fas fa-chevron-down"></i>
</span>
<select name="service">
<option value="1">Select Service</option>
<option value="2">Select Service</option>
<option value="3">Select Service</option>
</select>
</div>
</div>
<div class="row-info wow fadeInDown">
<div class="col-info-12 focus-date">
<span class="icon-form">
<i class="far fa-calendar-alt"></i>
</span>
<input type="text" placeholder="Select Date" onfocus="(this.type='date')">
</div>
</div>
<div class="row-info wow fadeInDown">
<div class="col-info-12">
<span class="icon-form">
<i class="fas fa-user"></i>
</span>
<select name="doctor">
<option value="1">Select Doctor</option>
<option value="2">Select Doctor</option>
<option value="3">Select Doctor</option>
</select>
</div>
</div>
<div class="row-info wow fadeInDown">
<div class="col-info-12">
<span class="icon-form">
<i class="far fa-clipboard"></i>
</span>
<textarea class="form-control" placeholder="Note to the doctor (optional)" maxlength="1000"></textarea>
</div>
</div>
</form>
</div><!--/form-your-info-->
<div class="themesflat-spacer clearfix" data-desktop="19" data-mobile="19" data-smobile="19"></div>
<h4 class="text-color-title-sidebar">
Payment Information:
</h4>
<div class="themesflat-spacer clearfix" data-desktop="19" data-mobile="19" data-smobile="19"></div>
<div class="form-payment-info">
<form action="#">
<div class="row-info wow fadeInDown">
<div class="col-info-12">
<label>Name on card</label>
<input type="text" placeholder="Dorothy Schneider">
</div>
</div>
<div class="row-info wow fadeInDown">
<div class="col-info-6">
<label>Card number</label>
<input type="text" placeholder="xxxx-xxxx-xxxx-xxxx">
</div>
<div class="col-info-6">
<ul class="list-payment">
<li>
<a href="#">
<i class="fab fa-cc-paypal"></i>
</a>
</li>
<li>
<a href="#">
<i class="fab fa-cc-visa"></i>
</a>
</li>
<li>
<a href="#">
<i class="fab fa-cc-mastercard"></i>
</a>
</li>
<li>
<a href="#">
<i class="fab fa-cc-amex"></i>
</a>
</li>
</ul>
</div>
</div>
<div class="themesflat-spacer clearfix" data-desktop="3" data-mobile="3" data-smobile="3"></div>
<div class="row-info wow fadeInDown">
<div class="col-info-6">
<label>Expiration date</label>
<input type="date">
</div>
<div class="col-info-6">
<label>
Security code
</label>
<input type="text" placeholder="CCV">
</div>
</div>
<div class="themesflat-spacer clearfix" data-desktop="3" data-mobile="3" data-smobile="3"></div>
<div class="row-info wow fadeInDown">
<div class="col-info-12">
<div class="check-form-payment">
<input type="checkbox">
<label>I accept terms and conditions and general policy</label>
</div>
</div>
</div>
</form>
<div class="themesflat-spacer clearfix" data-desktop="55" data-mobile="55" data-smobile="55"></div>
</div>
</div>
</div>
<div class="col-lg-4 col-md-12 col-sm-12">
<div class="themesflat-spacer clearfix" data-desktop="0" data-mobile="70" data-smobile="70"></div>
<div class="booking-summary">
<div class="title-booking wow fadeInDown">
<h4 class="text-color-white">Booking Summary</h4>
</div>
<div class="themesflat-spacer clearfix" data-desktop="30" data-mobile="30" data-smobile="30"></div>
<ul class="list-summary wow fadeInDown">
<li>
<ul class="date">
<li>
Date
</li>
<li class="w-right">
07/10/2020
</li>
</ul>
</li>
<li>
<ul class="hours">
<li>
Time09:30AM
</li>
<li class="w-right">
08:30 PM
</li>
</ul>
</li>
<li>
<ul class="name-doctor">
<li>
Doctor name
</li>
<li class="w-right">
Dr. Beatrice Willis
</li>
</ul>
</li>
</ul>
<div class="themesflat-spacer clearfix" data-desktop="21" data-mobile="21" data-smobile="21"></div>
<ul class="list-price wow fadeInDown">
<li>
<ul class="price">
<li>
Sit etiam convallis
</li>
<li class="w-right">
$80
</li>
</ul>
</li>
<li>
<ul class="price">
<li>
Curabitur praesent sed
</li>
<li class="w-right">
$140
</li>
</ul>
</li>
</ul>
<div class="themesflat-spacer clearfix" data-desktop="20" data-mobile="20" data-smobile="20"></div>
<ul class="total wow fadeInDown">
<li>
<ul class="total font-bold">
<li>
Total
</li>
<li class="w-right">
$220
</li>
</ul>
</li>
</ul>
<div class="themesflat-spacer clearfix" data-desktop="14" data-mobile="14" data-smobile="14"></div>
<div class="box-btn wow fadeInDown">
<a href="#" class="themesflat-button bg-accent btn-booking">
<span>Confirm and Pay<i class="fas fa-long-arrow-alt-right"></i> </span>
</a>
</div>
<div class="themesflat-spacer clearfix" data-desktop="20" data-mobile="20" data-smobile="20"></div>
</div>
</div>
</div>
<div class="row">
<div class="themesflat-spacer clearfix" data-desktop="254" data-mobile="200" data-smobile="100"></div>
</div>
</div>
</div>
<!--.page-content-->
</div>
<!--#inner-content-->
</div>
<!--site-content-->
</div>
<!--#content-wrap-->
</div>
<!--#main-content-->
<footer id="footer">
<div class="container">
<div class="row">
<div class="col-12">
<div class="box-sr">
<div class="text-subscribe">
<div class="themesflat-spacer clearfix" data-desktop="60" data-mobile="60" data-smobile="20"></div>
<h1 class="text-color-white">Enter Your Mail For subscribe</h1>
<div class="themesflat-spacer clearfix" data-desktop="58" data-mobile="58" data-smobile="0"></div>
</div>
<div class="form-contact">
<div class="themesflat-spacer clearfix" data-desktop="74" data-mobile="74" data-smobile="0"></div>
<form id="subscribe-form" action="#" method="GET" accept-charset="utf-8" class="form-submit contact-form wpcf7-form">
<div class="form-group">
<input type="email" name="email" value="" class="email" placeholder="Email Address" required>
<button type="submit" id="submit" name="submit" class="themesflat-button bg-color-2" role="button">SUBSCRIBE</button>
</div>
</form>
<div class="themesflat-spacer clearfix" data-desktop="40" data-mobile="40" data-smobile="1"></div>
</div>
</div>
</div>
</div>
<div class="row">
<div class="themesflat-spacer clearfix" data-desktop="95" data-mobile="95" data-smobile="25"></div>
</div>
<div class="row">
<div class="col-12">
<div class="box-list-footer">
<div class="box-list box-contact">
<div class="title-footer text-color-white">Contact Us</div>
<ul class="one-half first">
<li>
<span><i class="fas fa-map-marker-alt flat-icon-footer "></i></span>
<span>66 broklyant, new York India 3269 road.</span>
</li>
<li>
<span><i class="fa fa-phone-alt flat-icon-footer"></i></span>
<span><a href="tel:0123456789">012 345 678 9101</a></span>
</li>
<li>
<span><i class="fas fa-envelope flat-icon-footer"></i></span>
<span><a href="mailto:yourmail.@gmail.com">yourmail.@gmail.com</a></span>
</li>
</ul><!-- /.one-half -->
</div><!-- /.widget-services -->
<div class="box-list box-useful">
<div class="title-footer text-color-white"><a>Useful Link</a></div>
<ul class="one-half first">
<li><a href="about-us.html" title=""><span><i class="fa fa-square"></i></span>About Us</a></li>
<li><a href="doctor.html" title=""><span><i class="fa fa-square"></i></span>Team</a></li>
<li><a href="about-us.html" title=""><span><i class="fa fa-square"></i></span>Testomonial</a></li>
<li><a href="services.html" title=""><span><i class="fa fa-square"></i></span>Services</a></li>
</ul><!-- /.one-half -->
</div><!-- /.widget-services -->
<div class="box-list box-recent">
<div class="title-footer text-color-white"><a>Recent Post</a></div>
<ul class="one-half first">
<li >
<ul>
<li class="in">
<a href="blog-details.html">
<i class="fa fa-square"></i>
Bigg Ideas Business branding Info.
</a>
</li>
<li class="day">
<a href="blog-details.html" class="rubik-12-300" ><span><i class="far fa-calendar-alt"></i></span> December 7, 2021</a>
</li>
</ul>
</li>
<li class="recent">
<ul>
<li class="in">
<a href="blog-details.html">
<i class="fa fa-square"></i>
Bigg Ideas Business branding Info.
</a>
</li>
<li class="day">
<a href="blog-details.html" ><span><i class="far fa-calendar-alt"></i></span> December 7, 2021</a>
</li>
</ul>
</li>
</ul><!-- /.one-half -->
</div><!-- /.widget-services -->
<div class="box-list box-services ">
<div class="title-footer text-color-white"><a>Services</a></div>
<ul class="one-half first">
<li><a href="service-details.html" title=""><span><i class="fa fa-square"></i></span>Brand Design</a></li>
<li><a href="service-details.html" title=""><span><i class="fa fa-square"></i></span>Regular Graphics</a></li>
<li><a href="service-details.html" title=""><span><i class="fa fa-square"></i></span>Devolopment Worker</a></li>
<li><a href="service-details.html" title=""><span><i class="fa fa-square"></i></span>Ui/Ux Design</a></li>
</ul><!-- /.one-half -->
</div><!-- /.widget-services -->
</div><!-- /widget-box -->
</div>
</div>
<div class="row">
<div class="themesflat-spacer clearfix" data-desktop="95" data-mobile="50" data-smobile="40"></div>
</div>
</div>
<div class="footer-bottom">
<div class="container">
<div class="row">
<div class="logo-bottom">
<a href="">
<img src="assets/image/Logolight.png" alt="image">
</a>
</div>
<h3 class="copyright">
© yoursitename 2020 | all rights reserved
</h3>
<ul class="list-icon-bottom">
<li class="bottom-icon-active "><a href="#" title=""><i class="fab fa-facebook-f"></i></a></li>
<li class="bottom-icon-style "><a href="#" title=""><i class="fab fa-twitter"></i></a></li>
<li class="bottom-icon-style "><a href="#" title=""><i class="fab fa-instagram"></i></a></li>
<li class="bottom-icon-style " ><a href="#" title=""><i class="fab fa-linkedin-in"></i></a></li>
</ul>
</div>
</div>
</div><!--/.footer-bottom-->
</footer>
<div class="button-go-top">
<a href="#" title="" class="go-top">
<i class="fa fa-chevron-up"></i>
</a>
</div>
</div><!--#page-->
</div> <!--#wrapper-->
<!-- Javascript -->
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