Contact form on website
- or -
Post a project like this1865
$45
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- #2297865
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Full Stack Developer | PHP | Wordpress | MySQL| Laravel | JavaScript | React | Vue | Bootstrap | Tailwind
Amsterdam
Website Developer, Graphic Designer, Transcriber, Content writer, CAD Expert, Python Developer, Photo Editor, Web Scrapper, JAVA developer, Android developer, Wix/Shopify Expert,
Regensburg
✔Front-end Developer ✔HTML CSS ✔ SASS ✔ Email Templates ✔ Bootstrap ✔ JS ✔ Nuxt ✔ Vue.js ✔ Angular ✔ WordPress ✔
Karachi
PPH's Top Web Designer, Developer with Great reviews & communication specialized in WordPress | Shopify | Graphics designer - Label/Packaging/UI/UX | Web app/Software developer | mobile app developer
London
5797062543778146304818344611605503255148822155952427850630836242189918283821342985
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 ?
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Which framework you are using in your site?
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Hey RAY ,
Can we discuss the project?
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