med.mymedeng.ir Open in urlscan Pro
2606:4700:3032::ac43:d0e9 Public Scan

Back to summary

URL:
https://med.mymedeng.ir/
Submission: On March 02 via api (March 2nd 2024, 1:15:52 pm UTC) from US — Scanned from US

Form analysis
3 forms found in the DOM

#

<form class="form" action="#">
  <div class="row">
    <div class="col-lg-6 col-md-6 col-12">
      <div class="form-group">
        <input name="name" type="text" placeholder="Name">
      </div>
    </div>
    <div class="col-lg-6 col-md-6 col-12">
      <div class="form-group">
        <input name="email" type="email" placeholder="Email">
      </div>
    </div>
    <div class="col-lg-6 col-md-6 col-12">
      <div class="form-group">
        <input name="phone" type="text" placeholder="Phone">
      </div>
    </div>
    <div class="col-lg-6 col-md-6 col-12">
      <div class="form-group">
        <div class="nice-select form-control wide" tabindex="0"><span class="current">Department</span>
          <ul class="list">
            <li data-value="1" class="option selected ">Department</li>
            <li data-value="2" class="option">Cardiac Clinic</li>
            <li data-value="3" class="option">Neurology</li>
            <li data-value="4" class="option">Dentistry</li>
            <li data-value="5" class="option">Gastroenterology</li>
          </ul>
        </div>
      </div>
    </div>
    <div class="col-lg-6 col-md-6 col-12">
      <div class="form-group">
        <div class="nice-select form-control wide" tabindex="0"><span class="current">Doctor</span>
          <ul class="list">
            <li data-value="1" class="option selected ">Doctor</li>
            <li data-value="2" class="option">Dr. Akther Hossain</li>
            <li data-value="3" class="option">Dr. Dery Alex</li>
            <li data-value="4" class="option">Dr. Jovis Karon</li>
          </ul>
        </div>
      </div>
    </div>
    <div class="col-lg-6 col-md-6 col-12">
      <div class="form-group">
        <input type="text" placeholder="Date" id="datepicker">
      </div>
    </div>
    <div class="col-lg-12 col-md-12 col-12">
      <div class="form-group">
        <textarea name="message" placeholder="Write Your Message Here....."></textarea>
      </div>
    </div>
  </div>
  <div class="row">
    <div class="col-lg-5 col-md-4 col-12">
      <div class="form-group">
        <div class="button">
          <button type="submit" class="btn">Book An Appointment</button>
        </div>
      </div>
    </div>
    <div class="col-lg-7 col-md-8 col-12">
      <p>( We will be confirm by an Text Message )</p>
    </div>
  </div>
</form>

GET mail/mail.php

<form action="mail/mail.php" method="get" target="_blank" class="newsletter-inner">
  <input name="EMAIL" placeholder="Your email address" class="common-input" onfocus="this.placeholder = ''" onblur="this.placeholder = 'Your email address'" required="" type="email">
  <button class="btn">Subscribe</button>
</form>

GET mail/mail.php

<form action="mail/mail.php" method="get" target="_blank" class="newsletter-inner">
  <input name="email" placeholder="Email Address" class="common-input" onfocus="this.placeholder = ''" onblur="this.placeholder = 'Your email address'" required="" type="email">
  <button class="button"><i class="icofont icofont-paper-plane"></i></button>
</form>

Text Content

Get Pro
* Pro Version Available on Themeforest
* Pro Version Features
* 2+ premade home pages
* 20+ html pages
* Color Plate With 12+ Colors
* Sticky Header / Sticky Filters
* Working Contact Form With Google Map

* About
* Doctors
* Contact
* FAQ

* +880 1234 56789
* support@yourmail.com

* Home ►
* Home Page 1
* Doctos
* Services
* Pages ►
* 404 Error
* Blogs ►
* Blog Details
* Contact Us

* Home
* Home Page 1
* Doctos
* Services
* Pages
* 404 Error
* Blogs
* Blog Details
* Contact Us

Book Appointment