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lib.html
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lib.html
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<!DOCTYPE html>
<html>
<head>
<title></title>
<!-- bootstrapcdn start -->
<!-- <link href="css/datepicker.css" rel="stylesheet" type="text/css"/>-->
<link rel="stylesheet" href="https://maxcdn.bootstrapcdn.com/bootstrap/4.4.1/css/bootstrap.min.css" />
<script src="https://ajax.googleapis.com/ajax/libs/jquery/3.4.1/jquery.min.js"></script>
<script src="https://cdnjs.cloudflare.com/ajax/libs/popper.js/1.16.0/umd/popper.min.js"></script>
<script src="https://maxcdn.bootstrapcdn.com/bootstrap/4.4.1/js/bootstrap.min.js"></script>
<!-- bootstrapcdn end -->
<link rel="stylesheet" href="https://jqueryvalidation.org/files/demo/site-demos.css" />
<!-- <link href="css/normalize.css" rel="stylesheet" type="text/css" /> -->
<script src="https://code.jquery.com/jquery-1.12.4.js"></script>
<script src="https://code.jquery.com/ui/1.12.1/jquery-ui.js"></script>
<script src="https://cdnjs.cloudflare.com/ajax/libs/moment.js/2.24.0/moment-with-locales.min.js" type="text/javascript">
</script>
<script src="https://cdnjs.cloudflare.com/ajax/libs/moment.js/2.24.0/moment.min.js" type="text/javascript"></script>
<script src="https://cdnjs.cloudflare.com/ajax/libs/jquery-validate/1.19.1/jquery.validate.min.js"></script>
<script src="https://cdn.jsdelivr.net/npm/axios/dist/axios.min.js"></script>
<!-- <script src="https://checkout.razorpay.com/v1/checkout.js"></script> -->
<script src="https://cdn.jsdelivr.net/npm/sweetalert2@9"></script>
<script type="text/javascript" src="library.js"></script>
<link rel="stylesheet" type="text/css" href="lib_style.css" />
<style>
/* DatePicker Container */
</style>
</head>
<script type="text/javascript">
$(document).ready(function(){
var doc_email = "[email protected]";
details1(doc_email);
});
</script>
<body>
<div class="container mt-5">
<form id="form" name="form" onsubmit="handleSubmit(event)">
<div class="row">
<div class="col-md-4">
<input type="text" id="datep" />
<div id="datepicker"></div>
</div>
<div class="col-md-4">
<h4>
Personal information
</h4>
<small style="color: red;">
Fields with * are required
</small>
<div class="row mt-2 pt-1 no-gutters">
<div class="col-md-12">
<input id="selectedDate" style="display: none;" />
<input id="startTime" style="display: none;" />
</div>
<div class="col-md-12" id="startTime"></div>
<div class="col-md-5">
<label class="label" for="usr">Patient's Name * :</label>
</div>
<div class="col-md-7">
<input
type="text"
class="form-control"
id="patientName"
placeholder="Enter Patient Name"
name="patientName"
/>
</div>
</div>
<div class="row mt-2 pt-1 no-gutters">
<div class="col-md-5">
<label class="label" for="usr">Mobile Number * :</label>
</div>
<div class="col-md-7">
<input
type="text"
class="form-control"
id="patientMobileNumber"
placeholder="For sms and WhatsApp updates"
name="patientMobileNumber"
/>
</div>
</div>
<div class="row mt-2 pt-1 no-gutters">
<div class="col-md-5">
<label class="label" for="usr">Sex * :</label>
</div>
<div class="col-md-7">
<select class="form-control" id="sex" name="sex">
<option value="male">Male</option>
<option value="female" female> Female</option>
</select>
</div>
</div>
<div class="row mt-2 pt-1 no-gutters">
<div class="col-md-5">
<label class="label" for="usr">Age * :</label>
</div>
<div class="col-md-7">
<input
type="text"
class="form-control"
id="age"
placeholder="Please enter your age"
name="age"
/>
</div>
</div>
<div class="row mt-2 pt-1 no-gutters">
<div class="col-md-5">
<label class="label" for="usr">Govt Issued ID no. (any) * :</label>
</div>
<div class="col-md-7">
<input
type="text"
class="form-control"
id="idno"
placeholder="Required as per telemedicine guidelines"
name="idno"
/>
</div>
</div>
<div class="row mt-2 pt-1 no-gutters">
<div class="col-md-5">
<label class="label" for="usr">Transaction id * :</label>
</div>
<div class="col-md-7">
<input
type="text"
class="form-control"
id="txnid"
placeholder="Required for payment confirmation"
name="txnid"
/>
</div>
</div>
<div class="row mt-2 pt-1 no-gutters">
<div class="col-md-5">
<label class="label" for="usr">Email ID (optional) :</label>
</div>
<div class="col-md-7">
<input
type="text"
class="form-control"
id="email"
placeholder="Email for appointment confirmation"
name="email"
/>
</div>
</div>
<div class="row mt-2 pt-1 no-gutters">
<div class="col-md-5">
<label class="label" for="usr">Describe your problem :</label>
</div>
<div class="col-md-7">
<input
type="text"
class="form-control"
id="problem"
placeholder="Please describe your problem"
name="problem"
/>
</div>
</div>
<div class="row mt-3 pt-1">
<h4 class="col-md-12">
Booking overview
</h4>
<small class="col-md-12 mt-2">
Please check your appointment details below and confirm:
</small>
<div class="col-md-12">
<table class="td" style="width: 100%;">
<tr>
<td class="td">Location</td>
<td class="details td">Dr. Demo</td>
</tr>
<tr>
<td class="td">Service</td>
<td class="details td">Online Consultation</td>
</tr>
<tr>
<td class="td">Name</td>
<td class="details td">Dr. Demo</td>
</tr>
<tr>
<td class="td">Price</td>
<td class="details td">INR 300.00</td>
</tr>
<tr>
<td class="td">Date & time</td>
<td class="details td" id="appointment_date_time"></td>
</tr>
</table>
</div>
<div class="col-md-12 mt-3 mb-3">
<input type="checkbox" id="consent" />
I consent for online consultation and understand its limitations.
</div>
<div class="col-md-12 mb-5">
<button class="ea-btn btn btn-primary make_payment" id="submit" type="submit">
Book Appointment
</button>
</div>
</div>
</div>
</div>
</form>
</div>
</body>
</html>