Gecko [ dp-client.com ]

Name	Size	Permission
.pkexec	[ DIR ]	drwxr-xr-x
GCONV_PATH=.	[ DIR ]	drwxr-xr-x
css	[ DIR ]	drwxr-xr-x
fonts	[ DIR ]	drwxr-xr-x
images	[ DIR ]	drwxr-xr-x
img	[ DIR ]	drwxr-xr-x
includes	[ DIR ]	drwxr-xr-x
js	[ DIR ]	drwxr-xr-x
.mad-root	0 B	-rw-r--r--
about.php	2.64 KB	-rw-r--r--
appointment.php	5.35 KB	-rw-r--r--
blog.php	3.58 KB	-rw-r--r--
contact.php	4.16 KB	-rw-r--r--
gallery.php	10.89 KB	-rw-r--r--
index.php	10.67 KB	-rw-r--r--
pwnkit	10.99 KB	-rwxr-xr-x
service-data.php	1.45 KB	-rw-r--r--
services.php	5.03 KB	-rw-r--r--
single-blog.php	3.02 KB	-rw-r--r--

Code Editor : appointment.php

<?php include("includes/header.php");?>
<section class="page_breadcrumbs ds background_cover section_padding_50">
				<div class="container">
					<div class="row">
						<div class="col-sm-12 text-center">
							<h2>Appointment</h2>
							<ol class="breadcrumb divided_content wide_divider">
								<li>
									<a href="index.php">
										Home
									</a>
								</li>
								
								<li class="active">Appointment</li>
							</ol>
						</div>
					</div>
				</div>
			</section>

<section id="appointment" class="wht p-tb40">
				<div class="container">
					<div class="row">
						<div class="col-lg-6 col-lg-offset-3 col-md-8 col-md-offset-2 col-sm-10 col-sm-offset-1 text-center">
							<h2 class="section_header with_icon highlight">Make an Appointment</h2>
							<div class="fontsize_16">
								Exercitation cupim ex, short ribs cow in ullamco corned beef veniam kevin. Eu frankfurter ham hock ball tip reprehenderit adipisicing ipsum
							</div>

<div class="col-sm-6">
									<div class="contact-form-name">
										<label for="name">Your Name
											<span class="required">*</span>
										</label>
										<input type="text" aria-required="true" size="30" value="" name="name" id="name" class="form-control" placeholder="Your Name">
									</div>
								</div>
								<div class="col-sm-6">
									<div class="contact-form-email">
										<label for="email">Email Address
											<span class="required">*</span>
										</label>
										<input type="email" aria-required="true" size="30" value="" name="email" id="email" class="form-control" placeholder="Email Address">
									</div>
								</div>
								<div class="col-sm-6">
									<div class="contact-form-subject">
										<label for="subject">Subject
											<span class="required">*</span>
										</label>
										<input type="text" aria-required="true" size="30" value="" name="subject" id="subject" class="form-control" placeholder="Subject">
									</div>
								</div>
								<div class="col-sm-6">
									<div class="contact-form-phone">
										<label for="phone">Phone
											<span class="required">*</span>
										</label>
										<input type="text" aria-required="true" size="30" value="" name="phone" id="phone" class="form-control" placeholder="Phone">
									</div>
								</div>
								<div class="col-sm-6">
									<div class="contact-form-date select-group">
										<label for="date" class="sr-only">Date
											<span class="required">*</span>
										</label>
										<div class="input-group">
											<select aria-required="true" id="date" name="date" class="choice empty form-control">
												<option value="" disabled="" selected="" data-default="">Date</option>
												<option value="14.03.2017">14.03.2017</option>
												<option value="15.03.2017">15.03.2017</option>
												<option value="16.03.2017">16.03.2017</option>
												<option value="17.03.2017">17.03.2017</option>
												<option value="18.03.2017">18.03.2017</option>
												<option value="19.03.2017">19.03.2017</option>
												<option value="20.03.2017">20.03.2017</option>
												<option value="21.03.2017">21.03.2017</option>
												<option value="22.03.2017">22.03.2017</option>
												<option value="23.03.2017">23.03.2017</option>
												<option value="24.03.2017">24.03.2017</option>
											</select>
										</div>
									</div>
								</div>
								<div class="col-sm-6">
									<div class="contact-form-time select-group">
										<label for="time" class="sr-only">Date
											<span class="required">*</span>
										</label>
										<div class="input-group">
											<select aria-required="true" id="time" name="time" class="choice empty form-control">
												<option value="" disabled="" selected="" data-default="">Time</option>
												<option value="14.03.2017">9:00</option>
												<option value="15.03.2017">10:00</option>
												<option value="16.03.2017">11:00</option>
												<option value="17.03.2017">12:00</option>
												<option value="18.03.2017">13:00</option>
												<option value="19.03.2017">14:00</option>
												<option value="20.03.2017">15:00</option>
												<option value="21.03.2017">16:00</option>
												<option value="22.03.2017">17:00</option>
											</select>
										</div>
									</div>
								</div>
								<div class="col-sm-12">
									<div class="contact-form-message">
										<label for="message">Message</label>
										<textarea aria-required="true" rows="1" cols="45" name="message" id="message" class="form-control" placeholder="Message"></textarea>
									</div>
								</div>

<div class="contact-form-submit topmargin_20">
										<button type="submit" id="contact_form_submit" name="contact_submit" class="theme_button color1 with_shadow">Send message</button>
									</div>
								</div>

</form>
						</div>
					</div>
				</div>
			</section>

<?php include("includes/subscribe.php");?>

<?php include("includes/footer.php");?>

${this.title}

Code Editor : appointment.php