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contact.php
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contact.php
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<!DOCTYPE html>
<html lang="en">
<head>
<meta charset="utf-8" />
<title>MedAssist | Smart Health Prediction</title>
<meta name="viewport" content="width=device-width, initial-scale=1, shrink-to-fit=no" />
<link rel="icon" type="image/x-icon" href="gallery/img/ic.png">
<link rel="stylesheet" href="gallery/css/main.css" />
<link rel="stylesheet" href="gallery/css/bootstrap.min.css" />
<link rel="stylesheet" type="text/css" href="gallery/css/font-awesome-4.5.0/css/font-awesome.min.css" />
<style>
nav {
position: relative !important;
}
.jumbotron {
background-color: #ffffffb5 !important;
box-shadow: 0px 0px 8px 0px rgba(0,0,0,0.16);
}
.container-fluid {
background-image: url(gallery/img/nature-bird-bg.png);
background-size: contain;
}
.sndCont {
text-align: center;
}
.sndCont button {
padding: 8px 44px;
margin-top: 28px;
}
.sndCont button i {
margin: 0 6px;
}
.display-4 {
text-align: center;border-bottom: 1px solid #dfe3e6;
}
</style>
</head>
<body>
<?php include_once("header.php"); ?>
<div class="container-fluid p-2 justify-content-center row">
<div class="jumbotron col-8 pt-0 pb-2 mt-4">
<div class="w-100 display-4 mb-4 pb-1">Contact Us</div>
<form>
<div class="form-group row">
<label for="inputName" class="col-sm-2 col-form-label">Your Name</label>
<div class="col-sm-10">
<input type="text" class="form-control w-50" id="inputName" placeholder="Name">
</div>
</div>
<div class="form-group row">
<label for="inputEmail" class="col-sm-2 col-form-label">Email</label>
<div class="col-sm-10">
<input type="email" class="form-control w-75" id="inputEmail" placeholder="Email">
</div>
</div>
<fieldset class="form-group">
<div class="row">
<legend class="col-form-legend col-sm-2">Select One</legend>
<div class="col-sm-10">
<div class="form-check">
<label class="form-check-label">
<input class="form-check-input" type="radio" name="contactType" id="ct1" value="ct1" checked>
Suggetion / FeedBack / Request
</label>
</div>
<div class="form-check">
<label class="form-check-label">
<input class="form-check-input" type="radio" name="contactType" id="ct2" value="ct2">
Report a Problem / Support
</label>
</div>
<div class="form-check">
<label class="form-check-label">
<input class="form-check-input" type="radio" name="contactType" id="ct3" value="ct3">
Other Reason
</label>
</div>
</div>
</div>
</fieldset>
<div class="form-group row">
<label for="inputMsg" class="col-sm-2 col-form-label">Message</label>
<div class="col-sm-10">
<textarea class="form-control" id="inputMsg" placeholder="Your Message Here"></textarea>
</div>
</div>
<div class="form-group row justify-content-center">
<div class="col-sm-10 sndCont">
<button type="submit" class="btn btn-primary"><i class="fa fa-paper-plane" aria-hidden="true"></i> Send</button>
</div>
</div>
</form>
</div>
</div>
<?php include_once("footer.php"); ?>
</body>
</html>