
<head>
<meta content="text/html; charset=utf-8" http-equiv="Content-Type">
</head>

<head>
<meta content="text/html; charset=utf-8" http-equiv="Content-Type">
</head>

<div class="container content margin">
            <div class="inSite">
               	
               	
               	<?php $this->load->view('right_ar');?>
                
                
                <div class="container contentside">

                		<div class="conthdr"><h4><a href="<?php echo base_url();?>">الرئيسيـة</a>

                        	<span>/ <a href="">حجز إستشارة طبية</a></span></h4>

                        </div>

                        
                        

                        <div class="text-reg">


                  <form id="est_form" name="est_form"   action="<?php echo base_url();?>index.php/reserv2/send_msg" method="post">
  <center><?php echo $result?></center>

                        		<dl><br />



                                      <dt>الإسم</dt>

                                        <dd><input type="text" value="<?php echo $this->input->post('fname');?>"  name="fname" />
</dd>

                                      <dt>رقم الهاتف</dt>

                                        <dd><input name="phone" value="<?php echo $this->input->post('phone');?>" type="text" />		</dd>

                                        <dt>الإيميل</dt>

                                        <dd><input type="text"  value="<?php echo $this->input->post('email');?>" name="email" /></dd>



                                      <dt>العيادة المفضلة</dt>

                                        <dd>     

									  <select name="cat">  
									
									  <?php  
					                	$q_cats= $this->fun->get_cats('services');
					                	if($q_cats!=FALSE){
					                	foreach($q_cats->result() as $r):
					                	$cat=$r->id;
		                            ?>
 
                                      <option value="<?php echo $r->name_ar?>"><?php echo $r->name_ar?></option>
                                     <?php endforeach;}?>
									
									   </select> </dd>  
									   

									 <dt>إسم العيادة المتفرع منها</dt>
									
                                        <dd>     

									  <select name="cat2">  
									
									    <?php  
					                	$q_cats= $this->fun->getall('posts','services');
					                	if($q_cats!=FALSE){
					                	foreach($q_cats->result() as $r):
					                	$cat=$r->id;
		                            ?>
 
                                      <option value="<?php echo $r->name_ar?>"><?php echo $r->name_ar?></option>
                                     <?php endforeach;}?>

									
									   </select> </dd>     
									   
    



                                      <dt>الإستشارة</dt>

                                        <dd>     

										<textarea name="msg">  <?php echo $this->input->post('msg');?></textarea>

                                        

                                        </dd>

   

   <div class="reg-but"><a onclick="est_form.submit()" style="cursor:pointer"><img src="<?php echo base_url();?>template/ar/images/send.png" /></a> </div>

								</dl>

                        </form>

                        </div>

                

                </div>
                
                
                               	<?php $this->load->view('left_ar');?>

                
                
    		</div>
</div>
