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Current File : /home/webyoo/www/backup/allback/docteur-site/save_2405bh/contactez-nous.php

<?php
include "start.php";
?>
<!DOCTYPE html>
    <html lang="en">
        <head>
            <meta charset="utf-8">
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            <title>Docteurs.co.il - Page d'accueil</title>
            
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        </head>
        <body oncontextmenu="return false" id="page-top" data-spy="scroll" data-target=".navbar-custom">
            <!-- Navbar -->
            <nav class="navbar navbar-custom navbar-fixed-top" role="navigation">
                <div class="container" style="position:relative;">
                    <div class="navbar-header page-scroll">
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                        </button>
                        <a class="navbar-brand" href="index.php"><img src="img/logo_docteurs_gd.png" width="220px"/></a>
						<br><br><br><br><span style="text-transform: none; margin-top: 2px; color: rgb(156, 156, 156);">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Moteur de recherche <span style="color:#428bca;"><strong>n°1</strong></span> de médecins francophones en Israel</span>
                    </div>
                    
                    <!-- Collect the nav links, forms, and other content for toggling -->
                    <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>
                    </div>
                </div>
            </nav>
            <!-- End navbar -->
            
           <!-- Call to action -->
            <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;">&nbsp;&nbsp;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>
            <!-- End call to action -->
			
           
            
            
            
            
            <!-- Footer -->
            <footer id="footer" class="text-center">
                <div class="container">
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                        <p>Copyright &copy; 2015 - 2017 Docteurs.co.il</p>
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            <!-- End footer -->
            
            <!-- JavaScript -->
            <script src="js/jquery-1.10.2.js"></script>
			<script src="//code.jquery.com/ui/1.11.1/jquery-ui.js"></script>
			<link rel="stylesheet" href="//code.jquery.com/ui/1.11.1/themes/smoothness/jquery-ui.css">
            <script src="js/bootstrap.min.js"></script>
            <script src="js/jquery.easing.min.js"></script>
            <script src="js/jquery.backstretch.min.js"></script>
            <script src="js/scripts.js"></script>
			<script>
			  (function(i,s,o,g,r,a,m){i['GoogleAnalyticsObject']=r;i[r]=i[r]||function(){
			  (i[r].q=i[r].q||[]).push(arguments)},i[r].l=1*new Date();a=s.createElement(o),
			  m=s.getElementsByTagName(o)[0];a.async=1;a.src=g;m.parentNode.insertBefore(a,m)
			  })(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>



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