Current File : /home/inlingua/public_html/sensoriumpsychologists.com/backup/student/contact.php
<!DOCTYPE html>


<html>


  <head>


    <title>Shristi</title>


    <?php require("common/head_links.php");?>


    


  </head>


  <body class="hold-transition skin-blue sidebar-mini">


    <div class="wrapper">





      <?php require("common/header.php");?>


      


      <?php require("common/left_side_bar.php");?>





      <!-- Content Wrapper. Contains page content -->


      <div class="content-wrapper">


        <!-- Content Header (Page header) -->


        


        


        <section class="content-header">


          <h1> Contact Us</h1>


          


          


        </section>


    


    <!-- Main content -->


    <section class="content">


    <form role="form" method="post" enctype="multipart/form-data" onSubmit="return validate_form()">


      <div class="row"> 


        <!-- left column -->


        <div class="col-md-12"> 


          <!-- general form elements -->


          <div class="box box-primary">


            <div class="box-header with-border">


              


            </div>


            <!-- /.box-header --> 


            <!-- form start -->


            <div class="box-body">


              


              <div class="row">


                <div class="col-md-12">





                       <div class="col-md-12"> 


                            <h3>We’d love to hear from you</h3>


                            <p>Just fill out and submit the form below and we will respond to you as quickly as possible.</p>


                            <p>Thanks for your input, it is important to us! </p>


                            <h3>Business hours</h3>


                            <p>


                                <strong>


                                    Monday – Friday 9am to 5pm


                                    <br>


                                    Saturday – 9am to 2pm


                                    <br>


                                    Sunday – Closed


                                    <br /><br />


                                    <i class="fa fa-phone" aria-hidden="true" style="font-size:20px;"></i>&emsp; 08079450376,&emsp; +(91)-9810021054,&emsp; +(91)-8860061027


                                </strong>


                            </p>


                        </div> 





                </div>


          


            </div>  


            


              


            </div>


            <!-- /.box-body --> 


          </div>


          <!-- /.box -->


          


          <div class="box box-primary">


            <div class="box-header with-border">


              <h2 class="box-title">Send Us a Message</h2>


            </div>


            <!-- /.box-header --> 


            <!-- form start -->


            <div class="box-body">


              <div class="form-group">


                <div class="col-md-3">


                	<label for="">Name</label>


                	<input type="text" class="form-control" id="" name="" value="">


                </div>


                <div class="col-md-3">


                	<label for="">E-mail</label>


                	<input type="email" class="form-control" id="" name=""  value="">


                </div>


                <div class="col-md-3">


                	<label for="">Subject</label>


                	<input type="text" class="form-control" id="" name="" value="" >


                </div>


                <div class="col-md-3">


                	<label for="">Phone No.</label>


                	<input type="text" class="form-control" id="" name="" value="" >


                </div>


                


              </div>


              


              <div class="form-group">


                <div class="col-md-12">


                	<label for="">Message </label>


                	<textarea class="form-control" rows="5" id=""></textarea>


                </div>


                


                


              </div>


              


            </div>


            <!-- /.box-body --> 


          </div>


          


        </div>


        


      </div>


      


      


      <!-- /.row -->


      


      <div class="row">


        <div class="col-md-12">


          <button type="button" onClick="window.location.href='index.php'" class="btn btn-danger" style="margin-right:10px;margin-top:10px;">Back</button>


          <button type="submit" class="btn btn-success" style="margin-top:10px;">Send Message</button>


        </div>


      </div>


      </form>


      </section>


      <!-- /.content -->


    


 


      </div><!-- /.content-wrapper -->


      <?php require("common/footer.php");?>





      





    </div><!-- ./wrapper -->


<?php require("common/footer_links.php");?>











  </body>


</html>