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POST submit_form.php

<form action="submit_form.php" method="post" class="custom-form booking-form" id="bb-booking-form" role="form">
  <div class="text-center mb-5">
    <h2 class="mb-1">Contact us</h2>
    <p>Please fill out the form and we get back to you</p>
  </div>
  <div class="booking-form-body">
    <div class="row">
      <div class="col-lg-6 col-12">
        <input type="text" name="bb-name" id="bb-name" maxlength="40" class="form-control" placeholder="Full name" required="">
      </div>
      <div class="col-lg-6 col-12">
        <input type="tel" class="form-control" name="bb-phone" placeholder="Mobile 077-000-0000" maxlength="40" required="">
      </div>
      <div class="col-lg-6 col-12">
        <input class="form-control" type="email" name="user-email" placeholder="Your Email" required="" pattern="[a-zA-Z0-9._%+-]+@[a-zA-Z0-9.-]+\.[a-zA-Z]{2,}$">
      </div>
      <div class="col-lg-6 col-12">
        <select class="form-select form-control" name="bb-branch" id="bb-branch" aria-label="Default select example">
          <option selected="">Select Branches</option>
          <option value="Lomagundi Pharmacy">Lomagundi Pharmacy</option>
          <option value="Forestal Pharmacy">Forestal Pharmacy</option>
        </select>
      </div>
    </div>
    <textarea name="bb-message" rows="3" class="form-control" id="bb-message" maxlength="300" placeholder="Comment (Optionals)"></textarea>
    <div class="col-lg-4 col-md-10 col-8 mx-auto">
      <button type="submit" class="form-control">Submit</button>
    </div>
  </div>
</form>

Text Content

 * Home
 * Our Story
 * Services
 * Contact
 * Visit Us


LOMAGUNDI PHARMACY

11 Magamba Way, Box 303, Chinhoyi, ZW


About Us What we do

PRESCRIPTIONS, MEDICINE, TOILETRIES AND MORE!

Book a consultation


ABOUT US

Established in 2001 in the town of Chinhoyi, Lomagundi Pharmacy has proudly
served as a cornerstone of the local community for over two decades. From our
humble beginnings, we have grown to become an established household name,
dedicated to providing quality pharmaceutical services and healthcare products.

At Lomagundi Pharmacy, we prioritise the well-being of our community, offering
personalized care and a comprehensive range of products. Trust us as your
reliable partner in health and wellness.


View Product Offerings

OUR SHOP FRONT

OTC Section

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CONTACT US

Our Customer Service is on hand to help

Call us on:+263772263595


SERVICES

PRESCRIPTIONS

WOMEN'S UPKEEP

BABY DEPARTMENT

STATIONERY DEPARTMENT


CONTACT US

Please fill out the form and we get back to you

Select Branches Lomagundi Pharmacy Forestal Pharmacy
Submit


VISIT US

CONTACT INFORMATION

+263772263595

Email Us

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OPENING HOURS MON-FRI: 08:00 - 17:00 SAT: 08:00 - 13:00



OUR BRANCHES

Lomagundi Pharmacy

11 Magamba Way, Box 303, Chinhoyi, Zimbabwe



Forestal Pharmacy

Stand 4097, Machipisa shopping centre, Highfield, Zimbabwe

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