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<?xml version="1.0" encoding="UTF-8" ?>
<odoo>
<template id="contactus_template" name="Contact us" inherit_id="website.contactus">
<xpath expr="//section[hasclass('pb24')]" position="replace">
<div class="oe_structure"/>
<t t-call="theme_medicate.contactus_banner"/>
</xpath>
<xpath expr="//section[hasclass('o_colored_level')]" position="replace">
<div class="oe_structure"/>
<t t-call="theme_medicate.contactus_snippet"/>
<div class="col-lg-12">
<div class="container-get-in-touch w-100 mt-5 pt-5 float-left">
<h3 class="text-dark text-center font-weight-bold pb-3 pt-3">Get in Touch With Us</h3>
<section class="s_website_form" data-vcss="001" data-snippet="s_website_form">
<div class="contact-us-form-container p-5 w-100 float-left">
<form id="contactus_form"
action="/website/form/"
method="post"
enctype="multipart/form-data"
class="o_mark_required"
data-mark="*"
data-model_name="mail.mail"
data-success-mode="redirect"
data-success-page="/contactus-thank-you"
data-pre-fill="true">
<div class="mb-0 py-2 col-12 s_website_form_field s_website_form_custom s_website_form_required"
data-type="char" data-name="Field">
<div class="w-50 float-left " style="float:left">
<input type="text" placeholder="Enter your name" name="name" required="True"
style="background-color:#f5f6fa; border: none; outline: none;"
class="w-100 p-4 form-control s_website_form_input" id="contact1"
data-fill-with="name"/>
</div>
</div>
<div class="mb-0 py-2 col-12 s_website_form_field s_website_form_custom s_website_form_required"
data-type="email"
data-name="Field" style="margin-bottom:20px;">
<div class="w-50 float-left" style="float:left;">
<input type="email" placeholder="Enter your email"
style="background-color:#f5f6fa; border: none; outline: none; margin-left:24px;"
class="w-100 ml-4 p-4 form-control s_website_form_input"
name="email_from" required="True" data-fill-with="email"/>
</div>
</div>
<div class="mb-0 py-2 col-12 s_website_form_field s_website_form_custom"
data-type="char"
data-name="Field">
<div class="w-50 float-left mt-4" style="float:left">
<input type="tel" placeholder="Enter your Phone Number"
style="background-color:#f5f6fa; border: none; outline: none;"
class="w-100 p-4 form-control s_website_form_input" required="True"
data-fill-with="phone" name="phone"/>
</div>
</div>
<div class="mb-0 py-2 col-12 s_website_form_field s_website_form_dnone">
<div class="row s_col_no_resize s_col_no_bgcolor">
<div class="col-sm">
<input id="contact7"
type="hidden"
class="form-control s_website_form_input"
name="email_to"/>
</div>
</div>
</div>
<div class="mb-0 py-2 col-12 s_website_form_field s_website_form_custom"
data-type="char"
data-name="Field">
<div class="w-50 float-left mt-4" style="float:left">
<input type="text" placeholder="Subject"
style="background-color:#f5f6fa; border: none; outline: none; margin-left:24px;"
class="w-100 p-4 form-control s_website_form_input" required="True"
name="subject"/>
</div>
</div>
<div class="mb-0 py-2 col-12 s_website_form_field s_website_form_custom"
data-type="text"
data-name="Field">
<div class="float-left mt-4 contact-textarea" style="width: 102.5%;">
<textarea type="textarea" name="description"
placeholder="Write your message"
style="background-color:#f5f6fa; border: none; outline: none; margin-top: 30px;"
class="w-100 p-4 orm-control s_website_form_input "/>
</div>
</div>
<div class="w-100 float-left container-send-message-btn">
<a href="/contactus-thank-you"
class="btn-send-message text-decoration-none pt-3 pb-3 pl-4 pr-4 text-center text-white text-uppercase">
&#160;&#160;&#160;Send message&#160;&#160;&#160;
</a>
</div>
</form>
</div>
</section>
</div>
</div>
<t t-call="theme_medicate.contactus_map"/>
</xpath>
</template>
</odoo>