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POST /appointment

<form action="/appointment" method="POST">
  <input type="hidden" name="csrfmiddlewaretoken" value="CP84ZUuCM95d0hzGwt8886adnYgYXiriC5v4UGRzBQd9foTfpcokO5oyVhPYtVOo">
  <div class="row">
    <div class="form_head">
      <h2>Booking online</h2>
    </div>
  </div>
  <div class="row">
    <div class="col-lg-6 mb-5">
      <div class="form-group">
        <input name="first_name" type="text" class="form-control" id="" placeholder="First Name*" required="">
      </div>
    </div>
    <div class="col-lg-6 mb-5">
      <div class="form-group">
        <input name="last_name" type="text" class="form-control" id="" placeholder="Last Name*">
      </div>
    </div>
    <div class="col-lg-6 mb-5">
      <div class="form-group">
        <input name="phone" type="text" class="form-control" id="" placeholder="Phone Number*" required="">
      </div>
    </div>
    <div class="col-lg-6 mb-5">
      <div class="form-group">
        <input name="email" type="text" class="form-control" id="" placeholder="Email**" required="">
      </div>
    </div>
    <div class="col-lg-6 mb-5">
      <div class="form-group">
        <select class="form-control" id="1" name="treatment_id" required="">
          <option>Select Treatment</option>
          <option value="1">Abayanga</option>
          <option value="2">Udwarthanam</option>
          <option value="5">Baspa Sweda</option>
          <option value="6">Patra Pinda Sweda</option>
          <option value="7">Churnasweda</option>
          <option value="8">Upanaha Sweda</option>
          <option value="9">Avagana Sweda</option>
          <option value="10">Shastika Shali Pinda Sweda</option>
          <option value="11">Pizhichil </option>
          <option value="12">Shirovasthi</option>
          <option value="13">Shirodhara</option>
          <option value="14">Thakradhara</option>
          <option value="15">Dhanya Amala Dhara</option>
          <option value="16">Shirolepa</option>
          <option value="17">Kati Vasti</option>
          <option value="18">Urovasti</option>
          <option value="19">Prachanna</option>
          <option value="20">Jalukawacharana</option>
          <option value="21">Akshi Tharpana</option>
        </select>
      </div>
    </div>
    <div class="col-lg-6 mb-5">
      <div class="form-group">
        <select class="form-control" id="exampleFormControlSelect1" name="doctor_id" required="">
          <option>Select Doctor</option>
          <option value="1">Dr. Sruthi Sathyan</option>
          <option value="4">Dr. S. Sreeparvathy</option>
          <option value="5">Dr. K.R. Indira Devi</option>
          <option value="6">Dr. P.K Sudarsan Nair</option>
          <option value="12">Dr. Shilpa Das</option>
        </select>
      </div>
    </div>
    <div class="col-lg-6 mb-5">
      <div class="form-group">
        <input name="date" type="text" class="form-control" id="" placeholder="dd-mm-yyyy" required="">
      </div>
    </div>
    <div class="col-lg-6 mb-5">
      <div class="form-group">
        <select class="form-control" id="exampleFormControlSelect1" name="time" required="">
          <option>Time</option>
          <option value="10:30 AM">10:30 AM</option>
          <option value="11:00 AM">11:00 AM</option>
          <option value="11:30 AM">11:30 AM</option>
          <option value="12:00 PM">12:00 PM</option>
          <option value="12:30 PM">12:30 PM</option>
          <option value="01:00 PM">01:00 PM</option>
          <option value="01:30 PM">01:30 PM</option>
          <option value="02:00 PM">02:00 PM</option>
          <option value="02:30 PM">02:30 PM</option>
          <option value="03:00 PM">03:00 PM</option>
          <option value="03:30 PM">03:30 PM</option>
          <option value="04:00 PM">04:00 PM</option>
          <option value="04:30 PM">04:30 PM</option>
          <option value="05:00 PM">05:00 PM</option>
          <option value="05:30 PM">05:30 PM</option>
          <option value="06:00 PM">06:00 PM</option>
        </select>
      </div>
    </div>
    <div class="col-lg-12 mb-5">
      <label for="">Note:</label>
      <div class="form-group">
        <textarea id="" name="message"></textarea>
      </div>
    </div>
    <div class="col-lg-12 d-flex justify-content-center">
      <a href=""><button type="submit" class="booking_btn">Book Now</button></a>
    </div>
  </div>
</form>

Text Content

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 * ayushayurvedaotp@gmail.com
 * +91 9746 644 396

 * Home
 * About Us
 * Specialities
 * Treatments
 * Doctors
 * Facilities
 * Gallery
 * Blog
 * Packages
 * Contact Us


DOCTORS


OUR DOCTORS




OUR PANEL OF EXPERTS


DR. P.K SUDARSAN NAIR

MD (Ay.)
Chief Consultant
 * More


DR. K.R. INDIRA DEVI

BAM
Medical Director
 * More


DR. S. SREEPARVATHY

MD(Ay.)
Medical Superintendent
 * More


DR. SRUTHI SATHYAN

BAMS
Medical Officer
 * More


DR. SHILPA DAS

BAMS
Medical Officer
 * More

A perfect destination for Authentic Ayurveda to restore positive health and
experience holistic wellness..

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QUICK LINKS


 * About Us
 * Specialities
 * Treatment
 * Doctors
 * Book an Appoinment


CONTACT DETAILS



Ayush Ayurveda Hospital,
East Ottapalam, Palakkad District,
Kerala, India

+91 9746 644 396

ayushayurvedaotp@gmail.com

© 2023 AYUSH AYURVEDA Made with by Noviindus

Book an Appoinment



BOOKING ONLINE

Select Treatment Abayanga Udwarthanam Baspa Sweda Patra Pinda Sweda Churnasweda
Upanaha Sweda Avagana Sweda Shastika Shali Pinda Sweda Pizhichil Shirovasthi
Shirodhara Thakradhara Dhanya Amala Dhara Shirolepa Kati Vasti Urovasti
Prachanna Jalukawacharana Akshi Tharpana
Select Doctor Dr. Sruthi Sathyan Dr. S. Sreeparvathy Dr. K.R. Indira Devi Dr.
P.K Sudarsan Nair Dr. Shilpa Das

Time 10:30 AM 11:00 AM 11:30 AM 12:00 PM 12:30 PM 01:00 PM 01:30 PM 02:00 PM
02:30 PM 03:00 PM 03:30 PM 04:00 PM 04:30 PM 05:00 PM 05:30 PM 06:00 PM
Note:

Book Now