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index.html
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<!DOCTYPE html>
<html lang="en">
<head>
<meta charset="UTF-8">
<meta name="viewport" content="width=device-width,initial-scale=1">
<title>Form</title>
<link rel="stylesheet" href="styles/form-styles.css">
<link rel="stylesheet" href="styles/modal-styles.css">
</head>
<body>
<div class="form-container">
<div class="form">
<h1>Having questions? We are here for you</h1>
<form id="contact-form">
<div class="radio-inputs">
<input type="radio" id="member" name="member">
<label for="member">I have a membership</label>
</div>
<div class="radio-inputs">
<input type="radio" id="non-member" name="member" checked>
<label for="non-member">I don't have a membership</label>
</div>
<div class="text-inputs">
<label for="name" class="text-label" id="name-label">Name</label>
<input type="text" id="name" name="name" placeholder="Surname Name">
<p class="invalid-msg" id="name-invalid" style="display: none;">The name is not valid</p>
</div>
<div class="text-inputs">
<label for="birth" class="text-label" id="birth-label">Birth Date</label>
<input type="text" id="birth" name="birth" placeholder="DD/MM/YYYY">
<p class="invalid-msg" id="birth-invalid" style="display: none;">The birth date is not valid</p>
</div>
<div class="text-inputs">
<label for="email" class="text-label" id="email-label">Email</label>
<input type="text" id="email" name="email" placeholder="[email protected]">
<p class="invalid-msg" id="email-invalid" style="display: none;">The email address is not valid</p>
</div>
<div class="text-inputs">
<label for="phone" class="text-label" id="phone-label">Phone Number</label>
<input type="text" id="phone" name="phone" placeholder="+40xxx xxx xxx">
<p class="invalid-msg" id="phone-invalid" style="display: none;">The phone number is not valid</p>
</div>
<div class="text-input-address">
<label for="address" class="text-label" id="address-label">Address</label>
<input type="text" id="address" name="address" placeholder="Str bloc">
<p class="invalid-msg" id="address-invalid" style="display: none;">The address is not valid, please add all the details</p>
</div>
<div class="faq-dropdown">
<select id="faq" name="faq">
<option selected disabled style="visibility: hidden">Frequently asked questions</option>
</select>
<ul id="dropdown-options">
<li>Can you clinic recomment a doctor to me?</li>
<li>How can I get a copy of my medical records?</li>
<li>Can I visit a clinic in other cities?</li>
</ul>
</div>
<div class="text-inputs">
<label for="question" class="text-label">Your Question</label>
<textarea id="question" name="question" placeholder="Ask your question here"></textarea>
</div>
<div class="checkbox-input">
<p class="invalid-msg" id="terms-invalid" style="display: none;">Check the terms and conditions before proceeding</p>
<input type="checkbox" id="terms" name="terms">
<label for="terms" id="check">I accept the terms and conditions</label>
</div>
<div class="submit-btn">
<button type="submit" id="send-btn">Send</button>
</div>
</form>
</div>
</div>
<div class="modal">
<div class="modal-content">
<h1>Thank you!</h1>
<div class="review-msg">
<p>Your question has been successfully sent!</p>
<p>Our consultant will get to you shortly!</p>
</div>
<button id="ok-button">OK</button>
</div>
</div>
<script src="scripts/form-script.js"></script>
</body>
</html>