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: / home2 / ctsnewco / public_html / vikashhospitals.in /
Filename : book-appointment.php
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<?php require_once ('dbconn.php');
session_start();
if ($_SERVER["REQUEST_METHOD"] == "POST") {
    // Retrieve form data
    $first_name = $conn->real_escape_string($_POST['first_name']);
    $last_name = $conn->real_escape_string($_POST['last_name']);
    $email = $conn->real_escape_string($_POST['email']);
    $department = $conn->real_escape_string($_POST['department']);
    $subject = $conn->real_escape_string($_POST['subject']);
    $message = $conn->real_escape_string($_POST['message']);

    // Insert data into database
    $sql = "INSERT INTO apoinment_save (first_name, last_name, email, department, subject, message,page) 
                                VALUES ('$first_name', '$last_name', '$email', '$department', '$subject', '$message','book-apoinment')";
   if ($conn->query($sql) === TRUE) {
        $_SESSION['feedback'] = 'Thank you! Your appointment has been successfully completed.';
    } else {
        $_SESSION['feedback'] = 'Oops, something went wrong. Please try again later.';
    }

    header('location:index.php');
    exit;
}



?>








<?php
session_start();
if (isset($_SESSION['feedback'])) {
    echo "<script>alert('" . $_SESSION['feedback'] . "');</script>";
    unset($_SESSION['feedback']);
}
require_once ('header.php'); ?>

<style>
    .fab{
        line-height: 33px;
    }
</style>
    <!-- main-area -->
    <main>
        <!-- breadcrumb-area -->
        <section class="breadcrumb-area d-flex align-items-center"
            style="background-image:url(img/about/back-img.jpg)">
            <div class="container">
                <div class="row">
                    <div class="col-xl-6 offset-xl-3 col-lg-8 offset-lg-2">
                        <div class="breadcrumb-wrap text-center">
                            <div class="breadcrumb-title mb-30">
                                <h2>Appointment</h2>
                            </div>
                            <nav aria-label="breadcrumb">
                                <ol class="breadcrumb">
                                    <li class="breadcrumb-item"><a href="index.php">Home</a></li>
                                    <li class="breadcrumb-item active" aria-current="page">Appointment</li>
                                </ol>
                            </nav>
                        </div>
                    </div>
                </div>
            </div>
        </section>
        <!-- breadcrumb-area-end -->
        <!-- about-area -->
        <section id="contact" class="contact-area contact-bg pb-70 p-relative fix"
            style="background-image:url(img/an-bg/an-bg11.png); background-size: cover;background-repeat: no-repeat;">
            <div class="container">

                <div class="row">
                    <div class="col-lg-6">
                        <div class="contact-img">
                            <img src="img/about/book.jpg" alt="touch-illustration" style="max-width: 75%;margin-left: 195px;margin-top: 65px;">
                        </div>
                    </div>
                    <div class="col-lg-6">
                        <div class="section-title mb-60" style="padding-top: 50px;">
                            
                            <h2>Book Your Appointment</h2>
                            <p>Your Path to Better Health Begins Here</p>
                        </div>
                        <form action="" class="contact-form" method="post">
                            <div class="row">
                                <div class="col-lg-6">
                                    <div class="contact-field p-relative c-name mb-20">
                                        <input type="text" placeholder="First Name" name="first_name" maxlength='30' required>
                                    </div>
                                </div>
                                <div class="col-lg-6">
                                    <div class="contact-field p-relative c-name mb-20">
                                        <input type="text" placeholder="Last Name" name="last_name" maxlength='30' required>
                                    </div>
                                </div>
                                <div class="col-lg-6">
                                    <div class="contact-field p-relative c-email mb-20">
                                        <input type="email" placeholder="Write here your email" name="email" maxlength='30' required>
                                    </div>
                                </div>
                                <div class="col-lg-6">
                                    <div class="contact-field p-relative c-email mb-20">
                                         <select name="department">
                                             
                                            <?php
                                            
                                            $getdata = mysqli_query($conn , "SELECT * FROM `department`");
                                            if($getdata->num_rows > 0)
                                            {
                                                while($row = $getdata->fetch_assoc())
                                                {
                                                    ?>
                                                    <option value="<?= $row['name']; ?>"><?= $row['name']; ?></option>
                                                <?php
                                                }
                                                
                                            }
                                            
                                            ?>
                                        </select>
                                    </div>
                                </div>
                                <div class="col-lg-12">
                                    <div class="contact-field p-relative c-subject mb-20">
                                        <input type="text" placeholder="I would like to discuss" name="subject">
                                    </div>
                                </div>
                                <div class="col-lg-12">
                                    <div class="contact-field p-relative c-message mb-45">
                                        <textarea name="message" id="message" cols="30" rows="10"
                                            placeholder="Write comments"></textarea>
                                    </div>
                                    <div class="slider-btn">
                                        <button type="submit" class="btn ss-btn" data-animation="fadeInRight"
                                            data-delay=".8s">Send Message</button>
                                    </div>
                                </div>
                            </div>

                        </form>
                    </div>
                </div>

            </div>

        </section>
        <!-- about-area-end -->


    </main>
    <!-- main-area-end --><?php require_once ('footer.php'); ?>