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22 lines
1.1 KiB
HTML
22 lines
1.1 KiB
HTML
{% extends "templates/web.html" %}
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{% block title %}{{ _("Book Appointment") }}{% endblock %}
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{% block page_content %}
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<div class="container">
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<div class="text-center mb-5">
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<h3>Add details</h3>
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<h4>Selected date is {{ date }} at {{ time }}</h4>
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</div>
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<div class="row justify-content-center mt-3">
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<div class="col-md-4 align-items-center">
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<input class="form-control mt-3" type="text" name="customer_name" id="customer_name" placeholder="Your Name" required>
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<input class="form-control mt-3" type="tel" name="customer_number" id="customer_number" placeholder="Contact Number" required>
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<input class="form-control mt-3" type="text" name="customer_skype" id="customer_skype" placeholder="Skype" required>
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<textarea class="form-control mt-3" name="customer_notes" id="customer_notes" cols="30" rows="10" placeholder="Notes"></textarea>
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<button class="btn btn-primary form-control mt-3" onclick="submit()">Submit</button>
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</div>
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</div>
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</div>
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{% endblock %} |