489495df
MSV FM
MSV FM
<?php
$page_title = "Same-Day & Urgent Care: Book your Appointment Today";
$page_url = 'https://mandnhealthcare.com/same-day-urgent-care-book-your-appointment-today';
$keywords = 'health care professionals, specialized healthcare recruitment agency, short or long-term placements, care worker in UK';
$meta_description = 'Don\'t wait, get the care you need now! Same-day and urgent care appointments available in Davao City. Book your visit online in minutes and see a doctor today.';
$active = 2;
require 'partials/head.php' ?>
<link type="text/css" href="https://ajax.googleapis.com/ajax/libs/jqueryui/1.12.1/themes/south-street/jquery-ui.css" rel="stylesheet">
<link type="text/css" href="css/jquery.signature.css" rel="stylesheet">
<style>
#signature-div{
height: 130px;
cursor: crosshair;
border: 1px solid #ced4da;
position: relative;
}
.w-6{
width: 1.5rem;
}
.clear-sig-btn{
background-color: #fff;
border: 1px solid #ddd;
border-radius: 100%;
padding: 3px 5px;
position: absolute;
right: 8px;
}
.clear-sig-btn:hover{
background-color: #ddd;
box-shadow: 0px 0px 3px #ddd;
}
</style>
</head>
<body class="bg-light-color inner-page">
<div class="main-content">
<?php require 'partials/header.php'; ?>
<div class="inner-content relative" style="z-index: 10;">
<section class="section-row page-header-section">
<div class="container text-center">
<h1><?php echo $page_title; ?></h1>
<h2>Book Assessment</h2>
<ul class="breadcrumbs">
<li><a href="/" title="Home">Home</a></li>
<li class="active color-secondary"><span>Book Now</span></li>
</ul>
</div>
</section>
<section class="section-row contact-section">
<div class="container">
<div class="row">
<div class="col-sm-8 mx-auto">
<p class="mb-2 color-secondary font-weight-bold text-center">Book Now</p>
<h2 class="section-title mb-5 text-center">Book your Free Care Assessment today and fill out the form below.</h2>
<div>
<div class="mt-4 mb-4 text-center loader hidden"><img loading="lazy" src="images/loader.gif" height="256" width="256" alt="loading" /></div>
<div class="notif-message"></div>
<form class="form" method="post" action="sendmail.php" id="askOurTeam">
<input type="hidden" name="form_type" value="2">
<div class="form-group mb-2">
<label for="full_name">Full Name</label>
<input type="text" id="full_name" name="name" class="form-control" placeholder="" />
</div>
<div class="row mb-2">
<div class="form-group col-sm-6 col-12 mb-0">
<label for="phone">Phone</label>
<input type="text" id="phone" name="phone" class="form-control" placeholder="" />
</div>
<div class="form-group col-sm-6 col-12 mb-0">
<label for="email">Email</label>
<input type="email" id="email" name="email" class="form-control" placeholder="" />
</div>
</div>
<div class="row mb-2">
<div class="form-group col-sm-6 col-12 mb-0">
<label for="interested_in">Interested In</label>
<select class="form-control" id="interested_in" name="interested_in">
<option value="Hourly Care">Hourly Care</option>
<option value="Living Care">Living Care</option>
<option value="House Cleaning">House Cleaning</option>
<option value="House Cleaning">Day Centre</option>
</select>
</div>
<div class="form-group col-sm-6 col-12 mb-0">
<label for="what_service_do_you_require">What service do you required</label>
<select class="form-control" id="what_service_do_you_require" name="service_required">
<option value="Personal Care">Personal Care</option>
<option value="Elderly Care">Elderly Care</option>
<option value="Overnight Care">Overnight Care</option>
<option value="Companionship">Companionship</option>
<option value="Domestic Care">Domestic Care</option>
<option value="Enablement">Enablement</option>
<option value="Home Assistance">Home Assistance</option>
<option value="Home Care Service">Home Care Service</option>
<option value="Learning Disabilities">Learning Disabilities</option>
<option value="Palliative End of life care">Palliative / End of life care</option>
<option value="Cleaning & Ironing">Cleaning & Ironing</option>
<option value="Others">Others</option>
</select>
</div>
</div>
<div class="row mb-2">
<div class="form-group col-sm-6 col-12 mb-0">
<label for="assessment_date">Assessment Date</label>
<input type="text" id="assessment_date" class="form-control" name="assessment_date" placeholder="" />
</div>
<div class="form-group col-sm-6 col-12 mb-0">
<label for="assessment_time">Assessment Time</label>
<input type="text" class="form-control" id="assessment_time" name="assessment_time" placeholder="8:00am" />
</div>
</div>
<div class="row mb-2">
<div class="col-12 form-group mb-0">
<label for="full_address">Full Address</label>
<textarea id="full_address" class="form-control" name="address" rows="2"></textarea>
</div>
</div>
<div class="row mb-3">
<div class="col-12 form-group mb-0">
<label for="additional_info">Additional Info</label>
<textarea class="form-control" id="additional_info" name="additional_info" rows="3"></textarea>
</div>
</div>
<div class="mb-4 text-left form-group">
<label class="control-label">Signature</label>
<div id="signature-div" class="form-control w-100">
<button id="clear-sig" class="clear-sig-btn" title="Clear Signature">
<svg xmlns="http://www.w3.org/2000/svg" fill="none" viewBox="0 0 24 24" stroke-width="1.5" stroke="currentColor" data-slot="icon" class="w-6 h-6">
<path stroke-linecap="round" stroke-linejoin="round" d="M6 18 18 6M6 6l12 12" />
</svg>
</button>
</div>
<textarea id="signature-div64" name="signed" style="display: none;"></textarea>
</div>
<div class="mb-3">
<div class="g-recaptcha" data-sitekey="6LeTok0pAAAAAIsi29rFdaUVeyUOf1REf-TI5C_z"></div>
</div>
<div class="row">
<div class="form-group col-12">
<button type="submit" name="submit" class="default-btn">Book Now</button>
</div>
</div>
</form>
</div>
</div>
</div>
</div>
</section>
</div>
</div>
<?php require 'partials/subscribe.php'; ?>
<?php require 'partials/footer.php'; ?>
<?php require 'partials/foot.php'; ?>
<script src="https://ajax.googleapis.com/ajax/libs/jqueryui/1.12.1/jquery-ui.min.js"></script>
<script src="js/jquery.signature.min.js"></script>
<script type="text/javascript">
$('#signature-div').signature({color: '#000', syncField: '#signature-div64', syncFormat: 'PNG' });
$('#clear-sig').click(function(e){
e.preventDefault();
$('#signature-div').signature('clear');
$('#signature-div64').val('');
});
$("#askOurTeam").submit(function(e) {
var recaptcha = $("#g-recaptcha-response").val();
if(recaptcha === ""){
e.preventDefault();
alert("Please Check Recaptcha.");
return false;
}
e.preventDefault(); // avoid to execute the actual submit of the form.
var form = $(this);
var url = form.attr('action');
form.siblings('.notif-message').empty();
form.siblings('.loader').show();
form.hide();
$.ajax({
type: "POST",
url: url,
data: form.serialize(),
success: function(data){
form.siblings('.loader').hide();
// reset the form
form.siblings('.notif-message').append('<div class="success-notif notif text-center">Thank you for contacting us. We will get back to you as soon as possible.</div>');
form[0].reset();
// location.reload();
},
error:function(data){
form.siblings('.loader').hide();
form.siblings('.notif-message').append('<div class="error-notif text-center">Something went wrong. ' + data.message + '</div>');
form.show();
}
})
});
</script>
</body>
</html>