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| Current Path : /home/webyoo/www/backup/allback/docteur-site/save_2405bh/ |
| Current File : /home/webyoo/www/backup/allback/docteur-site/save_2405bh/contactez-nous.php |
<?php
include "start.php";
?>
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<br><br><br><br><span style="text-transform: none; margin-top: 2px; color: rgb(156, 156, 156);"> Moteur de recherche <span style="color:#428bca;"><strong>n°1</strong></span> de médecins francophones en Israel</span>
</div>
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<div class="">
<ul class="nav navbar-nav navbar-right">
<li class="page-scroll"><a href="espace-pro.php" style="font-size:13px;">Accès Professionnel</a></li>
<li class="page-scroll"><a href="contactez-nous.php" style="font-size:13px;">Contactez nous</a></li>
<li class=""><a href="leblog.php" style="font-size:13px;">Blog</a></li>
</ul>
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<!-- End navbar -->
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<section id="hero" style="height:1342px">
<div class="container">
<div class="inner">
<div class="row">
<div class="col-sm-offset-2 col-sm-8 text-center">
<div class="form-container">
<form action="" id="invite" method="POST" class="form-inline">
<div class="form-group">
<div style="text-align: center; font-size: 22px;">Contactez-nous<br><br></div>
<select name="objet" id="objet" style="width: 100%;margin-left:0px;margin-bottom:3px;" class="form-control input-lg">
<option value="">Sélectionnez un objet*</option>
<option value="medecin">Nouvelle inscription sur le site</option>
<option value="modif">Modification d'une fiche existante</option>
<option value="visiteur">Je suis un visiteur</option>
<option value="autre">Autre</option>
</select>
<br><input type="text" name="nom" id="nom" style="width: 100%;margin-left:0px;margin-bottom:3px;" class="form-control input-lg" placeholder="Votre nom*">
<br><input type="text" name="prenom" id="prenom" style="width: 100%;margin-left:0px;margin-bottom:3px;" class="form-control input-lg" placeholder="Votre prénom*">
<br><div id="acces" style="display:none;margin:5px;">Indiquez-nous votre adresse email ici afin de<br> vous envoyer vos codes d'accès :</div><input type="text" name="email" id="email" style="width: 100%;margin-left:0px;margin-left:0px;margin-bottom:3px;" class="form-control input-lg" placeholder="Votre email*">
<div id="opt_med">
<input type="text" name="recherche_spe_contact" id="recherche_spe_contact" style="width: 100%;margin-left:0px;margin-bottom:3px;" class="form-control input-lg" placeholder="Votre spécialité*">
<br><input type="text" name="adresse" id="adresse" style="width: 100%;margin-left:0px;margin-bottom:3px;" class="form-control input-lg" placeholder="Adresse complète*">
<br><input type="text" name="recherche_ville_contact" id="recherche_ville_contact" style="width: 100%;margin-left:0px;margin-bottom:3px;" class="form-control input-lg" placeholder="Votre ville*">
<br><select name="fk_consultation" id="fk_consultation" style="width: 100%;margin-left:0px;margin-bottom:3px;" class="form-control input-lg">
<option value="">Sélectionnez votre Kuppat Holim*</option>
<option value="1|||||">Maccabi</option>
<option value="|2||||">Clalit</option>
<option value="||3|||">Leumit</option>
<option value="|||4||">Meuhedet</option>
<option value="||||5|">Privé</option>
</select>
<br><input type="text" name="telcab" id="telcab" style="width: 100%;margin-left:0px;margin-bottom:3px;" class="form-control input-lg" placeholder="Téléphone Cabinet">
<br><input type="text" name="telfax" id="telfax" style="width: 100%;margin-left:0px;margin-bottom:3px;" class="form-control input-lg" placeholder="Téléphone Fax">
<br><input type="text" name="telmob" id="telmob" style="width: 100%;margin-left:0px;margin-bottom:3px;" class="form-control input-lg" placeholder="Téléphone Mobile">
<br><input type="text" name="telrdv" id="telrdv" style="width: 100%;margin-left:0px;margin-bottom:3px;" class="form-control input-lg" placeholder="Téléphone Rendez-vous">
<br><select name="fk_niv_fr" id="fk_niv_fr" style="width: 100%;margin-left:0px;margin-bottom:3px;" class="form-control input-lg">
<option value="">Sélectionnez votre Niveau de Français*</option>
<option value="1">Faible</option>
<option value="2">Bon</option>
<option value="3">Très bon</option>
<option value="4">Langue Maternelle</option>
</select>
</div>
<div id="visit" style="margin:11px;">Vous pouvez poser vos questions ici :</div><textarea style="height: 140px; width: 362px; font-size: 18px;margin-left:0px;" placeholder="Commentaires" name="commentaires" id="commentaires" class="form-control input-lg" rows="3"></textarea>
<div style="font-size:10px;color:#cc0000;">*Les champs accompagnés d'une étoile sont obligatoires</div>
</div>
<div id="refresh" class="result" style="display:none;"> Envoi en cours...</div>
<div id="result" class="result" style="display:none;"></div>
<br><br><a id="send_contact" class="btn btn-primary btn-lg">Envoyer!</a>
</form>
</div>
</div>
</div>
</div>
</div>
</section>
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})(window,document,'script','//www.google-analytics.com/analytics.js','ga');
ga('create', 'UA-58740838-1', 'auto');
ga('send', 'pageview');
</script>
<script type="text/javascript">
$(document).ready(function() {
$(document).on('click', "#send_contact", function() {
//
$('#send_contact').fadeOut();
objet = $('#objet').val();
nom = $('#nom').val();
prenom = $('#prenom').val();
email = $('#email').val();
recherche_spe_contact = $('#recherche_spe_contact').val();
adresse = $('#adresse').val();
recherche_ville_contact = $('#recherche_ville_contact').val();
telcab = $('#telcab').val();
telfax = $('#telfax').val();
telmob = $('#telmob').val();
telrdv = $('#telrdv').val();
fk_niv_fr = $('#fk_niv_fr').val();
fk_consultation = $('#fk_consultation').val();
commentaires = $('#commentaires').val();
//alert(objet);
$.post("send_contact.php", { objet : objet, nom_fr : nom , prenom_fr : prenom, email : email , recherche_spe_contact : recherche_spe_contact , adresse : adresse , recherche_ville_contact : recherche_ville_contact, tel_perso : telcab, tel_fax : telfax , tel_mobile : telmob , tel_rdv : telrdv, fk_niv_fr : fk_niv_fr , fk_consultation : fk_consultation, commentaires : commentaires }, function(data)
{
$("#refresh").fadeIn();
$("#refresh").delay( 1000 ).fadeOut();
$("#result").delay( 1800 ).html( data ).fadeIn();
$("#result").delay( 4000 ).fadeOut();
$('#send_contact').delay( 6000 ).fadeIn();
});
});
$('#recherche_spe_contact').autocomplete({
source : "liste_specialites.php",
minLength : 3
});
$('#recherche_ville_contact').autocomplete({
source : "liste_villes.php",
minLength : 1
});
$('#objet').on('change', function() {
if( this.value == 'medecin')
{
$("#opt_med").fadeIn();
$("#commentaires").attr('placeholder','Commentaires');
}else
{
$("#opt_med").fadeOut();
}
if( this.value == 'modif')
{
$("#acces").fadeIn();
$("#commentaires").attr('placeholder','Commentaires*');
}else
{
$("#acces").fadeOut();
}
});
});
</script>
</body>
</html>