pname=$pname; $objapp->gname=$gname; $objapp->email= $email; $objapp->phone= $phone; $objapp->tslot=$tslot; $objapp->adate=$adate; $objapp->rdate=$cur_date; $objapp->scan_type=$scan; $error_msg = $objapp->add_appointment(); if($error_msg!="2"){ // Send mail $to="kathikultrasound@gmail.com"; // Modified on 07-10-2015 KATHIKULTRASOUND@GMAIL.COM //$to="chitra.ganesh@yahoo.co.in"; $cc="shivashankar.ganesh@gmail.com"; //$to="uma@techweb.in"; //$cc="hari@techweb.in"; $subject = "Appointment Request"; $message = "Appointment request details \n From: ".stripslashes($_POST['txt_pname'])."\n Name: ".stripslashes($_POST['txt_pname']) ."\n Gynecologist Name: ".stripslashes($_POST['txt_gname'])."\n Phone: ".$_POST['txt_phone']."\n Email: ". $_POST['txt_email'] ."\n Time Slot: ".$_POST['tslot']."\n Type of Scan: ".$_POST['txt_scan']."\n Appointment Date: ".$_POST['app_date']; $headers = "MIME-Version: 1.0" . "\r\n"; $headers .= "Content-type:text/html;charset=iso-8859-1" . "\r\n"; $headers = "From: ". $_POST['txt_pname']."\r\n"; $headers .="cc: $cc"."\r\n"; //ini_set("SMTP","mail.techweb.in"); //ini_set("smtp_port",25); mail($to,$subject,$message,$headers); header("Location:success.php?msg=2"); } } } ?>
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Karthik Clinic & Karthik Ultrasound Scan Centre
MICO Layout, II Stage, Arekere, Bannerghatta Road, Bangalore - 560076


Appointment Request Form

Appointments are available from :  
 
Please fill in the details below to request for an appointment. We’ll call and confirm (ensure your mobile number is correct). By filling up the form you are requesting for an appointment, which will be confirmed by us over phone. Till you receive our call, this will only be a request and not a confirmed appointment.
 
Patient Name*
December 2019
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Gynecologist Name* ";?>
Email Id
Phone/Mobile Number*
January 2019
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Holidays
Appointment Request Date* Appointment Date "; }}?>
Timing Slot checked="checked" /> Morning checked="checked" /> Afternoon
checked="checked" /> Noon     checked="checked" /> Evening
Type of scan*
          
          
 
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