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bookingform.html
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<!DOCTYPE html>
<html lang="en">
<head>
<meta charset="UTF-8">
<meta name="viewport" content="width=device-width, initial-scale=1.0">
<link href="https://cdn.jsdelivr.net/npm/[email protected]/fonts/remixicon.css" rel="stylesheet">
<link href='https://unpkg.com/[email protected]/css/boxicons.min.css' rel='stylesheet'>
<link rel="preconnect" href="https://fonts.gstatic.com">
<link href="https://fonts.googleapis.com/css2?family=Poppins:wght@100;200;300;400;500;600;700&display=swap"
rel="stylesheet">
<link rel="stylesheet" href="https://stackpath.bootstrapcdn.com/font-awesome/4.7.0/css/font-awesome.min.css">
<script src="https://kit.fontawesome.com/62a41216fa.js" crossorigin="anonymous"></script>
<link rel="stylesheet" href="https://cdnjs.cloudflare.com/ajax/libs/font-awesome/6.0.0-beta2/css/all.min.css"
integrity="sha512-YWzhKL2whUzgiheMoBFwW8CKV4qpHQAEuvilg9FAn5VJUDwKZZxkJNuGM4XkWuk94WCrrwslk8yWNGmY1EduTA=="
crossorigin="anonymous" referrerpolicy="no-referrer" />
<link rel="stylesheet" href="assets/css/styles.css">
<link href="assets/images/logo0.jpg" rel="shortcut icon" />
<title>Book a session | Words Of Hope Trauma Relief Foundation </title>
<script src="assets/js/gsap.min.js"></script>
</head>
<body>
<a href="#" class="scrolltop" id="scroll-top">
<i class='bx bx-chevron-up scrolltop__icon'></i>
</a>
<header class="header subbed" id="header">
<nav class="nav bd-container">
<div class="nav__data">
<a href="/" class="nav__logo">
<img src="assets/images/logo123.png" class="menu-icon">
</a>
<div class="nav__toggle" id="nav-toggle">
<i class="ri-menu-line nav__burger"></i>
<i class="ri-close-line nav__close"></i>
</div>
</div>
<div class="nav__menu" id="nav-menu">
<ul class="nav__list">
<li class="dropdown__item">
<div class="nav__link dropdown__button"><a href="about-us.html">
Meet Us </a><i class="ri-arrow-down-s-line dropdown__arrow"></i>
</div>
<ul class="dropdown__menu">
<li>
<a href="peggy-okonedo.html" class="dropdown__link">
<i class="ri-user-line"></i> Peggy Okonedo
</a>
</li>
<li>
<a href="julie.html" class="dropdown__link">
<i class="ri-user-line"></i> Julie Park
</a>
</li>
<li>
<a href="diana.html" class="dropdown__link">
<i class="ri-user-line"></i> Diana Okechukwu
</a>
</li>
<li>
<a href="joyce.html" class="dropdown__link">
<i class="ri-user-line"></i> Joyce Danlami
</a>
</li>
</ul>
</li>
<li class="dropdown__item">
<div class="nav__link dropdown__button"><a href="therapy-services.html">
Services </a><i class="ri-arrow-down-s-line dropdown__arrow"></i>
</div>
<ul class="dropdown__menu">
<li>
<a href="training-and-conferences.html" class="dropdown__link">
<i class="ri-presentation-line"></i> Training and Conferences
</a>
</li>
<li>
<a href="sandtray-therapy.html" class="dropdown__link">
<i class="ri-user-heart-fill"></i> Sand Tray Therapy
</a>
</li>
<li>
<a href="play-therapy.html" class="dropdown__link">
<i class="ri-speak-fill"></i> Play Therapy & Non-Violent Communication
</a>
</li>
<li class="dropdown__subitem">
<div class="dropdown__link dropdown__button">
<a href="counselling-services.html" style="color: #fff">
<i class="ri-hand-heart-fill"></i><a href="counselling-services.html" style="color: #fff">
Counselling
</a><i class="ri-add-line dropdown__add"></i>
</a>
</div>
<ul class="dropdown__submenu">
<li>
<a href="individual-therapy.html" class="dropdown__sublink">
<i class="ri-user-heart-line"></i> Indivudial
</a>
</li>
<li>
<a href="couples-therapy.html" class="dropdown__sublink">
<i class="ri-group-fill"></i> Couples
</a>
</li>
<li>
<a href="teletherapy.html" class="dropdown__sublink">
<i class="ri-psychotherapy-fill"></i> Teletherapy
</a>
</li>
<li>
<a href="therapy-specialties.html" class="dropdown__sublink">
<i class="ri-donut-chart-fill"></i> Therapy Specialties
</a>
</li>
</ul>
</li>
</ul>
</li>
<li><a href="supervision-and-consultation.html" class="nav__link sub-2">Supervision</a></li>
<li><a href="fees.html" class="nav__link sub-2">FEES</a></li>
<li><a href="what-to-expect.html" class="nav__link sub-2">What To Expect</a></li>
<li><a href="frequently-asked-questions.html" class="nav__link sub-2">FAQ</a></li>
<li><a href="contact-us.html" class="nav__link">Contact Us</a></li>
</ul>
</div>
</nav>
</header>
<section class="about-us-2 bdcontainer">
<center>
<h1 class="abts">Therapy Booking</h1>
</center>
<section class="continer7 bd-container-ss delp">
<h1 style="text-align: left;">Fill this form to book a session</h1>
<form action="#" class="form">
<h3 style="text-align: center;">Personal Data</h3>
<div class="column">
<div class="input-box">
<label>Full Name</label>
<input name="name" placeholder="Enter full name" required />
</div>
<div class="input-box">
<label>Email Address</label>
<input name="email" placeholder="Enter email address" required />
</div>
<div class="input-box">
<label>Phone Number</label>
<input name="number" type="number" placeholder="Enter phone number" required />
</div>
</div>
<div class="column">
<div class="input-box">
<label>Birth Date</label>
<input type="date" placeholder="Enter birth date" required />
</div>
<div class="input-box">
<label>Gender</label>
<div class="select-box" required>
<select>
<option hidden>Select</option>
<option>Male</option>
<option>Female</option>
<option>Prefer not to say</option>
</select>
</div>
</div>
<div class="input-box">
<label>Type of Therapy</label>
<div class="select-box" required>
<select>
<option hidden>Select</option>
<option>Single</option>
<option>Married</option>
<option>Prefer not say</option>
</select>
</div>
</div>
</div>
<div class="input-box address">
<label>Address</label>
<input type="text" placeholder="Enter street address" required />
<div class="input-box">
<h3 style="text-align: center;">Service Requested</h3>
</div>
</div>
<div class="column">
<div class="input-box">
<label>Therapist Prefrence</label>
<div class="select-box" required>
<select required >
<option hidden>Select</option>
<option>Male</option>
<option>Female</option>
<option>Either</option>
</select>
</div>
</div>
<div class="input-box">
<label>Type of Therapy</label>
<div class="select-box" required>
<select>
<option hidden>Select</option>
<option>Free 15-minute counselling</option>
<option>Indivudial</option>
<option>Marital</option>
<option>Teletherapy</option>
<option>Sand Tray</option>
<option>Play</option>
</select>
</div>
</div>
</div>
<div class="input-box address">
<label>Reason for seeking treatment</label>
<input type="text" placeholder="Your Reason" required />
</div>
<div class="input-box address">
<div class="input-box">
<h3 style="text-align: center;">Appointment Data</h3>
</div>
</div>
<div class="input-box address">
<label>Times available for client</label>
<input type="time" required />
<input type="time" />
<input type="time" />
</div>
<div class="input-box address">
<label>Comments</label>
<input type="text" placeholder="" />
</div>
<button>Submit</button>
</form>
</section>
</section>
<br>
<br>
<br>
<br>
<br>
<br>
<br>
<br>
<br>
<section class="legger">
<div class="box-container bd-container-ss">
<div class="box1">
<h3>Words Of Hope Trauma Relief Foundation <i class="fa-solid fa-hands-praying"></i></h3>
<p>You can reach out and follow us on our social platforms.
</p>
<div class="share">
<a href="" class="fab fa-facebook"></a>
<a href="" class="fab fa-instagram"></a>
<a href="" class="fab fa-linkedin"></a>
<a href="" class="fab fa-twitter"></a>
<a href="" class="fab fa-youtube"></a>
</div>
</div>
<div class="box1">
<h3>Contact Info</h3>
<a href="tel:+2348060072992" class="links"><i class="fas fa-phone"></i> +234 806 007 2992 </a>
<a href="tel:+2349024558793" class="links"><i class="fas fa-phone"></i> +234 902 455 8793 </a>
<a href="mailto:[email protected]" class="links"><i class="fas fa-envelope"></i> [email protected] </a>
<a href="https://maps.app.goo.gl/o5HniW42vWs6cKaZA" target="_blank" rel="noopener" class="links"><i class="fas fa-map-marker-alt"></i> Jakande Estate,Isolo </a>
</div>
<div class="box1">
<h3>Quick Links</h3>
<a href="/" class="links"><i class="fas fa-home"></i>Home </a>
<a href="about-us.html" class="links"><i class="ri-group-fill"></i>Meet Us </a>
<a href="therapy-services.html" class="links"><i class="ri-donut-chart-fill"></i>Services </a>
<a href="supervision-and-consultation.html" class="links"><i class="ri-bar-chart-line"></i>Supervision </a>
<a href="fees.html" class="links"><i class="ri-cash-line"></i>Fees </a>
<a href="what-to-expect.html" class="links"><i class="ri-file-list-line"></i>What To Expect </a>
<a href="frequently-asked-questions.html" class="links"><i class="fas fa-question-circle"></i>FAQ</a>
<a href="contact-us.html" class="links"><i class="fa-solid fa-message"></i>Contact Us</a>
</div>
<div class="box1" id="signup">
<h3>Join Our Newsletter</h3>
<p>Get E-mail updates about our offers.</p>
<form action="" name="newsletter" method="post">
<input name="Email" type="email" placeholder="Your mail Address" id="email" class="email" required="required">
<button type="submit" class="doings-5">
Sign Up
</button>
<span id="msg" ></span>
</form>
</div>
</div>
<div class="credit">
© <script type="text/javascript">document.write(new Date().getFullYear());</script> Words of Hope Trauma Relief Foundation | All Rights Reserved |
<span>
<a href="privacy.html">
Privacy Policy
</a>
</span>
</div>
</section>
<script src="assets/js/main.js"></script>
<script src="assets/js/mixitup.min.js"></script>
<script src="assets/js/swiper-bundle.min.js"></script>
<script src="assets/js/gsap.min.js"></script>
</body>
</html>