|
@ -218,7 +218,7 @@ |
|
|
<span class="s_website_form_label_content">Medical concern</span> |
|
|
<span class="s_website_form_label_content">Medical concern</span> |
|
|
<span class="s_website_form_mark"> *</span> |
|
|
<span class="s_website_form_mark"> *</span> |
|
|
</label> |
|
|
</label> |
|
|
<div class="form-group s_website_form_field col-8 s_website_form_custom"> |
|
|
|
|
|
|
|
|
<div class="col-12 col-sm-12 col-md-12 col-lg-12 col-xl-8"> |
|
|
<select id="medical_concern" name="medical_concern" class="form-control s_website_form_input"> |
|
|
<select id="medical_concern" name="medical_concern" class="form-control s_website_form_input"> |
|
|
<option name="medical_concern" value="have medical concern" label="J'ai un souci médical à signaler"></option> |
|
|
<option name="medical_concern" value="have medical concern" label="J'ai un souci médical à signaler"></option> |
|
|
<option name="medical_concern" selected="selected" value="have no medical concern" label="Je n'ai pas de souci médical à signaler"></option> |
|
|
<option name="medical_concern" selected="selected" value="have no medical concern" label="Je n'ai pas de souci médical à signaler"></option> |
|
@ -249,7 +249,7 @@ |
|
|
<span class="s_website_form_label_content">Name of the contact</span> |
|
|
<span class="s_website_form_label_content">Name of the contact</span> |
|
|
</label> |
|
|
</label> |
|
|
<span class="s_website_form_mark"> *</span> |
|
|
<span class="s_website_form_mark"> *</span> |
|
|
<div class="col-12 col-sm-12 col-md-6 col-lg-4 col-xl-3"> |
|
|
|
|
|
|
|
|
<div class="col-12 col-sm-12 col-md-6 col-lg-6 col-xl-6"> |
|
|
<input type="text" class="form-control s_website_form_input" name="medical_contact_name" value="" required="1" id="medical_contact_name" style="cursor: auto;"/> |
|
|
<input type="text" class="form-control s_website_form_input" name="medical_contact_name" value="" required="1" id="medical_contact_name" style="cursor: auto;"/> |
|
|
</div> |
|
|
</div> |
|
|
</div> |
|
|
</div> |
|
@ -260,7 +260,7 @@ |
|
|
<span class="s_website_form_label_content">Phone of the contact</span> |
|
|
<span class="s_website_form_label_content">Phone of the contact</span> |
|
|
</label> |
|
|
</label> |
|
|
<span class="s_website_form_mark"> *</span> |
|
|
<span class="s_website_form_mark"> *</span> |
|
|
<div class="col-12 col-sm-12 col-md-6 col-lg-4 col-xl-3"> |
|
|
|
|
|
|
|
|
<div class="col-12 col-sm-12 col-md-6 col-lg-6 col-xl-6"> |
|
|
<input type="text" class="form-control s_website_form_input" name="medical_contact_phone" value="" required="1" id="medical_contact_phone" style="cursor: auto;"/> |
|
|
<input type="text" class="form-control s_website_form_input" name="medical_contact_phone" value="" required="1" id="medical_contact_phone" style="cursor: auto;"/> |
|
|
</div> |
|
|
</div> |
|
|
</div> |
|
|
</div> |
|
|