ibelive.tw
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43.254.19.86
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Submitted URL: http://ibelive.tw/reservation
Effective URL: https://ibelive.tw/reservation
Submission: On January 29 via api from US — Scanned from US
Effective URL: https://ibelive.tw/reservation
Submission: On January 29 via api from US — Scanned from US
Form analysis 1 forms found in the DOM
<form id="orders__form">
<div class="booking">
<div class="booking__row">
<div class="booking__itemhalf">
<label for="name" class="booking__row-label">姓名</label>
<input type="text" id="name" class="booking__input" name="name">
</div>
<div class="booking__itemhalf">
<label class="booking__row-label">性別</label>
<select class="booking__select" name="gender">
<option value="">請選擇</option>
<option value="male">男性</option>
<option value="female">女性</option>
</select>
</div>
</div>
<div class="booking__row">
<div class="booking__itemhalf">
<label for="phone" class="booking__row-label">住家電話</label>
<input type="tel" class="booking__input" name="phone">
</div>
<div class="booking__itemhalf">
<label for="cellphone" class="booking__row-label">手機號碼</label>
<input type="tel" class="booking__input" name="cellphone">
</div>
</div>
<div class="booking__row">
<div class="booking__itemhalf">
<label for="email" class="booking__row-label">電子信箱</label>
<input type="email" class="booking__input" name="email">
</div>
<div class="booking__itemhalf">
<label class="booking__row-label">身分</label>
<select class="booking__select" name="identity">
<option value="">請選擇身分</option>
<option value="self">本人</option>
<option value="family">家人</option>
<option value="other">其他</option>
</select>
</div>
</div>
<div class="booking__row">
<div class="booking__itemhalf">
<div class="booking__itemhalf-item">
<label class="booking__row-label">預約項目</label>
<div class="booking__checkbox">
<div class="booking__checkbox-row">
<input type="checkbox" class="checkbox project__box" id="project_checkitem_1" name="reservation_project[]" value="助聽器保養檢修(30 分鐘): 限聽寶會員">
<label for="project_checkitem_1" class="checkbox__text">助聽器保養檢修(30 分鐘): 限聽寶會員</label>
</div>
<div class="booking__checkbox--msg">注意事項：助聽器保養包含助聽器的聲音檢測、外觀檢查、清潔消毒與真空除濕等，不包含拆機維修。</div>
<div class="booking__checkbox-row">
<input type="checkbox" class="checkbox project__box" id="project_checkitem_2" name="reservation_project[]" value="免費聽力檢測(1小時)">
<label for="project_checkitem_2" class="checkbox__text">免費聽力檢測(1 小時)</label>
</div>
<div class="booking__checkbox-row">
<input type="checkbox" class="checkbox project__box" id="project_checkitem_3" name="reservation_project[]" value="助聽器諮詢試聽(1.5小時)">
<label for="project_checkitem_3" class="checkbox__text">免費助聽器諮詢試聽(1.5 小時)</label>
</div>
</div>
</div>
</div>
<div class="booking__itemhalf">
<div class="booking__itemhalf-item">
<label class="booking__row-label">預約區域</label>
<select class="booking__select booking__select-area">
<option value="">請選擇區域</option>
<option>北部</option>
<option>中部</option>
<option>南部</option>
<option>宜花東區域</option>
<option>無</option>
</select>
</div>
<div class="booking__itemhalf-item">
<label class="booking__row-label">預約門市</label>
<select class="booking__select booking__select-store" disabled="">
</select>
</div>
<div class="booking__itemhalf-resultbox">
<label class="booking__row-label">預約門市及電話</label>
<textarea class="booking__input-result booking__input-notallowed" name="reservation_store" readonly=""></textarea>
</div>
<div class="booking__itemhalf-item">
<label for="date" class="booking__row-label">預約日期</label>
<input type="input" id="date" class="booking__input" name="reservation_date" placeholder="請選擇日期" readonly="" disabled="">
</div>
<div class="booking__itemhalf-item">
<label for="mail" class="booking__row-label">預約時段</label>
<div class="booking__checkbox">
<div class="booking__checkbox-row booking__checkbox--disabled">
<input type="radio" class="radio project__box booking__input-notallowed" id="time1" name="times" value="上午" disabled="">
<label for="time1" class="radiobox__text">上午</label>
</div>
<div class="booking__checkbox-row booking__checkbox--disabled">
<input type="radio" class="radio project__box booking__input-notallowed" id="time2" name="times" value="下午" disabled="">
<label for="time2" class="radiobox__text">下午</label>
</div>
</div>
</div>
</div>
</div>
<!-- hidden -->
<input type="hidden" id="store_id" name="store_id" value="">
<input type="hidden" id="reservation_store_mail" name="reservation_store_mail" value="reservation_store_mail">
<!-- error msg to Max -->
<span style="text-align: center; color: red;" id="error_msg__orders"></span>
<div class="g-recaptcha" data-sitekey="6Lfoe0oUAAAAAHAqfgg15TVzx7fpdd-T1sQNyGhA">
<div style="width: 304px; height: 78px;">
<div><iframe title="reCAPTCHA" width="304" height="78" role="presentation" name="a-gr7815a7fnv6" frameborder="0" scrolling="no"
sandbox="allow-forms allow-popups allow-same-origin allow-scripts allow-top-navigation allow-modals allow-popups-to-escape-sandbox allow-storage-access-by-user-activation"
src="https://www.google.com/recaptcha/api2/anchor?ar=1&k=6Lfoe0oUAAAAAHAqfgg15TVzx7fpdd-T1sQNyGhA&co=aHR0cHM6Ly9pYmVsaXZlLnR3OjQ0Mw..&hl=en&v=QUpyTKFkX5CIV6EF8TFSWEif&size=normal&cb=93t046k6s1dq"></iframe></div>
<textarea id="g-recaptcha-response" name="g-recaptcha-response" class="g-recaptcha-response" style="width: 250px; height: 40px; border: 1px solid rgb(193, 193, 193); margin: 10px 25px; padding: 0px; resize: none; display: none;"></textarea>
</div><iframe style="display: none;"></iframe>
</div>
</div>
</form>Text Content
vip@ibelive.com.tw 0800 211430 Toggle navigation Toggle navigation * 最新消息 * 關於聽寶 * 認識聽寶 * 助聽器介紹 * 聽寶服務 * 合作夥伴 * 聽力專欄 * 聽力初篩 * 常見問題 * 聽寶商品 * iBelive助聽器 * 訂閱制助聽器 * 智慧配件 * 輔聽器 * 營養保健品 * 聽友分享 * 全國據點 * 線上預約 線上預約 Online booking 線上預約 Online booking 請填寫以下欄位資訊 -------------------------------------------------------------------------------- 請務必填寫正確資料，收到資訊後，我們將竭誠為您服務。 姓名 性別 請選擇 男性 女性 住家電話 手機號碼 電子信箱 身分 請選擇身分 本人 家人 其他 預約項目 助聽器保養檢修(30 分鐘): 限聽寶會員 注意事項：助聽器保養包含助聽器的聲音檢測、外觀檢查、清潔消毒與真空除濕等，不包含拆機維修。 免費聽力檢測(1 小時) 免費助聽器諮詢試聽(1.5 小時) 預約區域 請選擇區域 北部中部南部宜花東區域無 預約門市 預約門市及電話 預約日期 預約時段 上午 下午 預約送出後，請等待專人回覆確定預約 確認預約 聽寶助聽中心首創5分鐘快速聽力測試，幫助消費者 快速篩檢聽力問題，並擁有先進的設備，準確地分析您的聽力情況，免去醫院或診所的往返直接給您最專業的聽力服務。 免費諮詢專線 0800 211430 快速連結 首頁 關於聽寶 聽寶的家鄉 最新消息 合作夥伴 助聽器介紹 全國據點 聽寶線上購 線上預約 聽力初篩 Copyright © 2018 iBelive All rights reserved. Designed by LAZYWeb Top