index.html 2.71 KB
Newer Older
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
<!DOCTYPE html>
<html lang="en">
  <head>
    <meta charset="UTF-8" />
    <meta http-equiv="X-UA-Compatible" content="IE=edge" />
    <meta name="viewport" content="width=device-width, initial-scale=1.0" />
    <link rel="stylesheet" href="stylesheet.css" />

    <script
      src="https://kit.fontawesome.com/3ecc744bca.js"
      crossorigin="anonymous"
    ></script>
    <title>Front page</title>
  </head>
  <body>
    <div style="text-align: center">
      <div class="form-body">
        <h1 class="header-tag">Schedule a call with a Health Coach</h1>
        <form action="backend.php" method="POST" id="usrform">
          <div class="input-group">
            <div class="input-group-addon">
              <i class="fas fa-user fa-lg" style="color: skyblue"></i>
              <input
                type="text"
                name="name"
                class="formStyle"
                placeholder="Name (required)"
                required
              />
            </div>
          </div>

          <div class="input-group">
            <div class="input-group-addon">
              <i class="far fa-envelope fa-lg" style="color: skyblue"></i>
              <input
                type="email"
                name="email"
                class="formStyle"
                placeholder="Email (required)"
                required
              />
            </div>
          </div>

          <div class="input-group">
            <div class="input-group-addon">
              <i
                class="fas fa-map-marker-alt fa-lg"
                style="color: skyblue; padding: -40px"
              ></i>
              <input
                type="text"
                name="address"
                class="formStyle"
                placeholder="Address (required)"
                required
              />
            </div>
          </div>

          <div class="input-group">
            <div class="input-group-addon">
              <i
                class="fas fa-phone fa-lg"
                style="color: skyblue; padding: -40px"
              ></i>
              <input
                type="number"
                name="phone"
                class="formStyle"
                placeholder="Phone Number (required)"
                required
              />
            </div>
          </div>

          <textarea
            style="margin-bottom: 2em; padding: 0px"
            rows="15"
            cols="50"
            name="message"
            form="usrform"
          >
          </textarea>

          <div>
            <input
              class="formButton"
              type="submit"
              name="save"
              value="Submit"
            />
          </div>
        </form>
      </div>
    </div>
  </body>
</html>