Form for the appointment.

An example of an appointment form for a website. A simple option without complex dependencies and special widgets. Responsive design, modal and normal, ajax submission, neutral style.

Dr. Alexander P. SmithDr. Leslie TaylorDr. R. Glenn Williams

Preferred appointment time

9-1010-1111-1213-1414-1515-16

If the desired time is taken:

Assign earlyAssign LaterMove to another day

This is my first time visiting your clinic.

Your contact details

Leave your contact details. Our manager will contact you to clarify the request.

Your full name *

Contact number *

Please enter your gender

malefemaleother

Date of your birth

JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember

Your private message

I have read and agreed with Terms of Use and Privacy Policy. *

Send me a copy of the message. (Authorization required) *

It is possible to support and debug styles for any fields and widgets of the component, study for the design of any site. Write to contacts. The modal view can be seen here: Appointment form. This example installs only on the licensed version of QuickForm.

Installation order.

• 1.Download file appointment.qf3.zip.
• 2. Import the file through the project manager of the QuickForm component.
• 3. Specify your e-mail address in the project settings.
• 4. Display the form on a website page (more).