Form Block

Component 1

Book your appointment

Search 14,600 doctors and find the best care near you

                    
                      <div class="clinic-template py-4">
                        <div class="container">
                          <section class="muse-section py-0">
                            <div class="bg-blue-400 rounded-12 p-3 p-md-5 p-sm-4">
                              <div class="row py-2">
                                <div class="col-lg-6 pl-3 pl-lg-4">
                                  <h2 class="display-4 text-white mb-lg-4">Book your appointment</h2>
                                  <p class="fs-20 text-white lh-lg pr-lg-5 mb-4 mb-lg-3">Search 14,600 doctors and find the best care near you</p>
                                </div>
                                <div class="col-lg-6 pl-3 pl-lg-5">
                                  <div class="ml-lg-2">
                                    <div class="rounded-12 bg-white p-4 ml-xl-4 mr-xl-2">
                                      <form class="line-form p-md-2">
                                        <div class="mb-4">
                                          <select class="form-select form-select-lg">
                                            <option>Full Name</option>
                                          </select>
                                        </div>
                                        <div class="mb-4">
                                          <select class="form-select form-select-lg">
                                            <option>Department</option>
                                          </select>
                                        </div>
                                        <div class="mb-4">
                                          <select class="form-select form-select-lg">
                                            <option>Date</option>
                                          </select>
                                        </div>
                                        <div class="mb-2">
                                          <select class="form-select form-select-lg">
                                            <option>Time</option>
                                          </select>
                                        </div>
                                        <div class="form-check form-check-sm mb-4">
                                          <input class="form-check-input" type="checkbox" id="gridCheck">
                                          <label class="form-check-label text-gray-600" for="gridCheck">
                                            I agree to the <a href="#" class="text-gray-600">Terms & Conditions</a>
                                          </label>
                                        </div>
                                        <button class="btn btn-lg btn-block btn-primary">Book now</button>
                                      </form>
                                    </div>
                                  </div>
                                </div>
                              </div>
                            </div>
                          </section>
                        </div>
                      </div>
                    
                  

Component 2

Contact us

Thousands of agents ready to help you.

It is a long established fact that a reader will be distracted by the readable content of a page when looking at its layout.

Get a quote in 24 hours!

                    
                      <div class="container">
                        <section class="muse-section">
                          <div class="row">
                            <div class="col-lg-6 pt-0 pt-md-5 mt-0 mt-md-5 pr-md-5">
                              <h6>Contact us</h6>
                              <h3 class="h1">Thousands of agents ready to help you.</h3>
                              <p class="big lh-lg text-black-600 mb-4">It is a long established fact that a reader will be distracted by the readable content of a page when looking at its layout.</p>
                            </div>
                            <div class="col-lg-6">
                              <div class="rounded-6 overflow-hidden shadow-dark-80">
                                <h4 class="bg-success text-white mb-0 py-4 px-4 px-md-5">Get a quote in 24 hours!</h4>
                                <form class="p-4 p-lg-5">
                                  <div class="row">
                                    <div class="col-md-6 mb-4">
                                      <label for="exampleFormControlInput1" class="form-label text-black">First name</label>
                                      <input type="text" class="form-control form-control-lg" id="exampleFormControlInput1" placeholder="First name" value="John">
                                    </div>
                                    <div class="col-md-6 mb-4">
                                      <label for="exampleFormControlInput2" class="form-label text-black">Last name</label>
                                      <input type="text" class="form-control form-control-lg" id="exampleFormControlInput2" placeholder="Last name" value="Lee">
                                    </div>
                                  </div>
                                  <div class="row">
                                    <div class="col-md-12 mb-4">
                                      <label for="exampleFormControlInput3" class="form-label text-black">Email address</label>
                                      <input type="email" class="form-control form-control-lg" id="exampleFormControlInput3" placeholder="Email address" value="John@fabrx.co">
                                    </div>
                                  </div>
                                  <div class="row">
                                    <div class="col-md-12 mb-4">
                                      <label for="exampleFormControlInput4" class="form-label text-black">Message</label>
                                      <textarea class="form-control form-control-lg" rows="5" id="exampleFormControlInput4" placeholder="Message">Hello šŸ‘‹ Iā€™m launc|</textarea>
                                    </div>
                                  </div>
                                  <div class="row align-items-center">
                                    <div class="col-sm-8">
                                      <div class="form-check form-check-sm form-check-inline mb-3">
                                        <input class="form-check-input" type="checkbox" value="" id="flexCheckDefault10">
                                        <label class="form-check-label text-secondary" for="flexCheckDefault10">I agree to the <a href="#" class="text-gray-600">Terms & Conditions</a></label>
                                      </div>
                                    </div>
                                    <div class="col-sm-4 text-sm-right">
                                      <button type="button" class="btn btn-lg btn-success">Send</button>
                                    </div>
                                  </div>
                                </form>
                              </div>
                            </div>
                          </div>
                        </section>
                      </div>
                    
                  

Component 3

Get a quote in 24 hours.

Zombie ipsum reversus ab viral inferno, nam rick grimes malum cerebro.

Multiple users? we offer custom tailored packages including premium support and detailed analytics.

                    
                      <div class="agency-template bg-dark">
                        <div class="container">
                          <section class="muse-section">
                            <div class="row pt-0 pt-md-4">
                              <div class="col-lg-6">
                                <div class="pr-0 pr-md-5 pt-4 mt-md-2">
                                  <h3 class="display-4">Get a quote in 24 hours.</h3>
                                  <p class="big mt-2 lh-lg">Zombie ipsum reversus ab viral inferno, nam rick grimes malum cerebro.</p>
                                </div>
                              </div>
                              <div class="col-lg-6">
                                <div class="pl-lg-5 ml-xl-5">
                                  <div class="p-sm-4 p-2 bg-black-800 rounded-12">
                                    <form class="row m-0 dark-form">
                                      <div class="col-md-12 mb-1 mt-1">
                                        <p class="small lh-lg">Multiple users? we offer custom tailored packages including premium support and detailed analytics.</p>
                                      </div>
                                      <div class="col-sm-6 mb-3">
                                        <input type="text" placeholder="First Name" class="form-control form-control-lg">
                                      </div>
                                      <div class="col-sm-6 mb-3">
                                        <input type="text" placeholder="Last Name" class="form-control form-control-lg">
                                      </div>
                                      <div class="col-md-12 mb-3">
                                        <input type="email" placeholder="Email" class="form-control form-control-lg">
                                      </div>
                                      <div class="col-md-12 mb-3">
                                        <textarea class="form-control form-control-lg" placeholder="Message" rows="3"></textarea>
                                      </div>
                                      <div class="col-md-12 mb-2">
                                        <button type="button" class="btn btn-lg btn-block btn-danger">Send</button>
                                      </div>
                                    </form>
                                  </div>
                                </div>
                              </div>
                            </div>
                          </section>
                        </div>
                      </div>