Contact form on website
- or -
Post a project like this1878
$45
- Posted:
- Proposals: 16
- Remote
- #2297865
- Awarded
Description
Experience Level: Entry
Hello, we need to place a contact form, which includes:
name, email, phone, date (with calendar), time (with choice), choose an insurance (from a list), choose a doctor (from a list), has the patient seen this doctor before (yes or no options), what is the reason for your visit (from a list) and comments section.
The date and time picker should look like this site: http://newyorkmanhattanobgyn.com/schedule-an-appointment/
and the other info like on zocdoc , for exemple: https://www.zocdoc.com/doctor/monica-c-martin-md-95533
We'll need the contact form to be on a new page and linked to some buttons on the site.
And we'll need one icon removed.
name, email, phone, date (with calendar), time (with choice), choose an insurance (from a list), choose a doctor (from a list), has the patient seen this doctor before (yes or no options), what is the reason for your visit (from a list) and comments section.
The date and time picker should look like this site: http://newyorkmanhattanobgyn.com/schedule-an-appointment/
and the other info like on zocdoc , for exemple: https://www.zocdoc.com/doctor/monica-c-martin-md-95533
We'll need the contact form to be on a new page and linked to some buttons on the site.
And we'll need one icon removed.
RAY W.
100% (43)Projects Completed
27
Freelancers worked with
21
Projects awarded
41%
Last project
19 Nov 2021
United States
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-
RAY , can i see your website please ?
-
Which framework you are using in your site?
-
Hey RAY ,
Can we discuss the project?
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