www.itderbd.nextwebservice.com
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Submission: On October 12 via automatic, source certstream-suspicious — Scanned from FI
Submission: On October 12 via automatic, source certstream-suspicious — Scanned from FI
Form analysis
1 forms found in the DOMPOST #
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<div class="row">
<div class="col-md-6">
<div class="form-group">
<label class="fw-bolder" for="name">Patient Name<span class=" text-danger">*</span> </label>
<input type="text" name="name" id="name" class="form-control" placeholder="Name" required="">
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</div>
<div class="col-md-6">
<div class="form-group">
<label class="fw-bolder" for="phone">Patient Phone<span class=" text-danger">*</span> </label>
<input type="number" name="phone" id="phone" class="form-control" onkeyup="changeSubmitBtn()" placeholder="Phone" required="">
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<div class="col-md-6">
<div class="form-group">
<label class="fw-bolder" for="email">Patient Email<span class=" text-danger"></span> </label>
<input type="email" name="email" id="email" class="form-control" placeholder="Email">
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</div>
<div class="col-md-6 ">
<div class="form-group">
<label class="fw-bolder" for="name">Appoinment Date<span class=" text-danger">*</span> </label>
<input type="text" id="appoinment_date" name="appoinment_date" class="form-control flatpickr-disabled-range custom-date-picker custom-cursor-pointer flatpickr-input" value="12-10-2024" placeholder="Date" required="">
</div>
</div>
<div class="col-md-12">
<div class="form-group">
<label class="fw-bolder" for="name">Patient Problem<span class=" text-danger">*</span> </label>
<textarea class="form-control" cols="2" rows="2" name="problem" id="problem" placeholder="Problem" required=""></textarea>
</div>
</div>
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<p class="text-center mt-3">
<input type="submit" id="submitBtn" class="btn_1" value="Submit">
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Text Content
Menu mobile * Home * Branch * Doctors * Service * Appointment * Contact Us * Login YOUR DREAM TREATMENT Embark on a Journey of Radiant Transformation at Tiayra: Unveiling Beauty, Nurturing Wellness Book Appointment DISCOVER THE ONLINE BRANCHES! Usu habeo equidem sanctus no. Suas summo id sed, erat erant oporteat cu pri. In eum omnes molestie. Sed ad debet scaevola, ne mel. 📍 Bashudhara Branch : House # 15, (5th Floor), Block # A, EBL Bank Building, Bashundhara Main Road, Bashundhara R/A,Dhaka. 📍Eskaton Branch: OTTOWAN CENTER, (8th floor) 121/5 New Eskaton Road, Dhaka. 📍 Uttara Branch: House #4, Road #9, Sector #1, (Besides Scholastica School), Uttara Model Town, Dhaka. OUR RESPECTED PHYSICIANS Cum doctus civibus efficiantur in imperdiet deterruisset. COMMON SERVICES Usu habeo equidem sanctus no. Suas summo id sed, erat erant oporteat cu pri. ‹› OUR SERVICES Nec graeci sadipscing disputationi ne, mea ea nonumes percipitur. Nonumy ponderum oporteat cu mel, pro movet cetero at. PHOTO GALLERY Tiayra Photo Gallery: Where every image finds its stage to shine, captivating viewers with its seamless elegance and empowering creators to share their artistry with the world ‹› TESTIMONIAL The perfect look comes with the perfect care and Tiayra have it for me. Not once but took their several services and I am really pleased. Wishing them go higher as they deserve. - Maymuna Binte Manir Student It was really a fantastic experience and they care so well that fades away any confusion or afraid. - Arika Jaman Homemaker My job is to fly high to all directions and so my skin goes on roughness and several environmental problem. I took services of Tiayra and now I am confident about my glow even after going under roughness. - Jennyfer Jinia Traveller Previous Next VIDEO GALLERY Watch More On Youtube IT'S TIME TO APPOINTMENT Demo Text OPEN HOURS: Sunday-Friday: 09:00 AM - 10:00 PM. EMAIL: info@Untree.co CALL: +88 0173 058 8404 APPOINMENT HERE -------------------------------------------------------------------------------- Patient Name* Patient Phone* Patient Email Appoinment Date* Patient Problem* SOURCES * Home * Branch * Doctors * Services * Appoinment * Contact Us CONTACT WITH US OTTOWAN CENTER, (8th floor) 121/5 New Eskaton Road, Dhaka. * +880 140 0403 214 * tiayra.aesthetic@gmail.com FOLLOW US * * * * -------------------------------------------------------------------------------- * Terms and conditions * Privacy © 2024 Tiayra. Developed By WBSoftwares. JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember SunMonTueWedThuFriSat 293012345678910111213141516171819202122232425262728293031123456789