111 lines
3.7 KiB
HTML
111 lines
3.7 KiB
HTML
<div data-v-component-plugin-contact-form-form data-v-storage="database" data-v-confirm-email="true" data-v-name="contact-form-appointment">
|
|
|
|
<div class="notifications" data-v-notifications>
|
|
|
|
<div class="alert alert-danger d-flex alert-dismissable" role="alert" data-v-notification-error>
|
|
|
|
<div class="icon align-middle me-2">
|
|
<i class="align-middle la la-2x lh-1 la-exclamation-triangle"></i>
|
|
</div>
|
|
|
|
<div class="flex-grow-1 align-self-center text-small">
|
|
<div>
|
|
<div data-v-notification-text>
|
|
This is a placeholder for a notification message.
|
|
</div>
|
|
</div>
|
|
</div>
|
|
|
|
|
|
<button type="button" class="btn-close align-middle" data-bs-dismiss="alert" aria-label="Close">
|
|
<span aria-hidden="true">
|
|
<!-- <i class="la la-times"></i> -->
|
|
</span>
|
|
</button>
|
|
</div>
|
|
|
|
<div class="alert alert-success d-flex alert-dismissable d-flex" role="alert" data-v-notification-success>
|
|
|
|
<div class="icon align-middle me-2">
|
|
<i class="align-middle la la-2x lh-1 la-check-circle"></i>
|
|
</div>
|
|
|
|
<div class="flex-grow-1 align-self-center align-middle" data-v-notification-text>
|
|
This is a placeholder for a success message.
|
|
</div>
|
|
|
|
<button type="button" class="btn-close align-middle" data-bs-dismiss="alert" aria-label="Close">
|
|
<span aria-hidden="true">
|
|
<!-- <i class="la la-times"></i> -->
|
|
</span>
|
|
</button>
|
|
</div>
|
|
|
|
<div class="alert alert-primary d-flex alert-dismissable d-flex" role="alert" data-v-notification-info>
|
|
|
|
<div class="icon align-middle me-2">
|
|
<i class="align-middle la la-2x lh-1 la-info-circle"></i>
|
|
</div>
|
|
|
|
<div class="flex-grow-1 align-self-center" data-v-notification-text>
|
|
This is a placeholder for a info message.
|
|
</div>
|
|
|
|
<button type="button" class="btn-close" data-bs-dismiss="alert" aria-label="Close">
|
|
<span aria-hidden="true">
|
|
<!-- <i class="la la-times"></i> -->
|
|
</span>
|
|
</button>
|
|
</div>
|
|
|
|
</div>
|
|
|
|
<form action="" method="post">
|
|
<input type="hidden" class="form-control" placeholder="First name" name="firstname-empty">
|
|
<input type="hidden" class="form-control" placeholder="Email" name="csrf" data-v-csrf>
|
|
|
|
<div class="row">
|
|
<div class="col">
|
|
<input type="text" class="form-control" placeholder="First name" name="first_name" required>
|
|
</div>
|
|
<div class="col">
|
|
<input type="text" class="form-control" placeholder="Last name" name="last_name" required>
|
|
</div>
|
|
</div>
|
|
|
|
<div class="row mt-4">
|
|
<div class="col">
|
|
<input type="email" class="form-control" placeholder="Email" name="email" required>
|
|
</div>
|
|
</div>
|
|
|
|
<div class="row mt-4">
|
|
<div class="col">
|
|
<input type="datetime-local" class="form-control" placeholder="Date" name="datetime" required>
|
|
</div>
|
|
</div>
|
|
|
|
<div class="row mt-4">
|
|
<div class="col">
|
|
<textarea class="form-control" name="message" rows="3" placeholder="Message"></textarea>
|
|
</div>
|
|
</div>
|
|
|
|
|
|
<!-- if these hidden inputs are filled then ignore, robots -->
|
|
|
|
<input type="text" class="form-control d-none" placeholder="Contact form" name="contact-form">
|
|
|
|
<input type="text" class="form-control d-none" placeholder="Subject" name="subject-empty">
|
|
|
|
<input type="text" class="form-control visually-hidden" placeholder="Last name" name="lastname-empty" tabindex="-1">
|
|
|
|
|
|
<div class="row mt-4">
|
|
<div class="col">
|
|
<button type="submit" class="btn btn-primary">Make appointment <i class="la la-long-arrow-alt-right ms-1"></i>
|
|
</button>
|
|
</div>
|
|
</div>
|
|
</form>
|
|
</div> |