<!-- Button trigger modal -->
<!-- Modal -->

<?php
if(isset($_POST['booking'])){
  //  print_r($_POST);die;
 // Get the submitted form data
 
 $timeslot = $_POST['timeslot'];
 $name = $_POST['name'];
 $phone = $_POST['phone'];
 $email = $_POST['email'];

  $to = "keerthistar12@gmail.com";
         $phone = $phone;
         $emailSubject = ucfirst($name).' Applied for '.ucwords($timeslot);
        
         $message .= "<h1>$message</h1>";
         
         $header = $email;
         $header .= "Cc:afgh@somedomain.com \r\n";
         $header .= "MIME-Version: 1.0\r\n";
         $header .= "Content-type: text/html\r\n";
        
         $retval = mail ($to,$emailSubject,$phone,$header);
         
         if( $retval == true ) {
            echo "Message sent successfully...";
         }else {
            echo "Message could not be sent...";
         }
}
?>

<section>
<div class="modal fade" id="exampleModal" tabindex="-1" aria-labelledby="exampleModalLabel" aria-hidden="true">
  
  <div class="modal-dialog">
    <div class="modal-content">
      <div class="modal-header">
        <h5 class="modal-title" id="star_health"></h5>
        
        <button type="button" class="btn-close" data-bs-dismiss="modal" aria-label="Close"></button>
      </div>
      <div class="modal-body">
      <div class="col-md-10 mt-3">
      <form method="post" onsubmit = "return modal_validation()">
            <div class="col-md-10 mt-1">
            <input type="text" name="name" id="name" placeholder="Enter Name" class="form-control">
           
            </div><br>
           
            <div class="col-md-10 mt-1">
             <select name="timeslot" id="timeslot" class="form-control">
                 <option value="">Select plans</option>
                 <option value="">Personal accident cover</option>
                 <option value="">Cover for maternity</option>
                 <option value="">Health Checkup</option>
                 <option value="">Women Care</option>
                 <option value="">Individual / Family Plan</option>
                 <option value="">Senior Citizen</option>
                 <option value="">FHO</option>
                 
             </select><br>
            </div>

                    <div class="col-md-10 mt-1">
                    <input type="number" name="phone" id="phone" placeholder="Enter Phone" class="form-control">
                    </div><br>

                    <div class="col-md-10 mt-1">
                    <input type="email" name="email" id="email" placeholder="Enter Email" class="form-control">
                    
                    </div>
                  </div><br>
              
                    <div class="modal-footer">
                    <button type="button" class="btn btn-secondary" data-bs-dismiss="modal">Close</button>
                    <input type="submit" class="btn btn-primary modal-button" value="Submit" name="booking">
                    </div>
                       </form>
      
                       </div>
                    </div>
                 </div>
             </div>
         </section>
         
         
         <?php
if(isset($_POST['submit'])){
  //  print_r($_POST);die;
 // Get the submitted form data
 
 $email = $_POST['email'];
 $name = $_POST['name'];
 $subject = $_POST['subject'];
 $message = $_POST['message'];

  $to = "keerthistar12@gmail.com";
         $subject = $subject;
         $emailSubject = ucfirst($name).' Applied for '.ucwords($subject);
        
         $message .= "<h1>$message</h1>";
         
         $header = $email;
         $header .= "Cc:afgh@somedomain.com \r\n";
         $header .= "MIME-Version: 1.0\r\n";
         $header .= "Content-type: text/html\r\n";
        
         $retval = mail ($to,$emailSubject,$message,$header);
         
         if( $retval == true ) {
            echo "Message sent successfully...";
         }else {
            echo "Message could not be sent...";
         }
}
?>

<!---------- contact---------->
  
  <section id="contact" class="contact">
    <div class="section-title">
        <h2>Contact</h2>
     </div>
    <div class="container">

      <div class="row justify-content-center" data-aos="fade-up">

        <div class="col-lg-10">

          <div class="info-wrap">
            <div class="row">
              <div class="col-lg-4 info">
              <!--   <i class="bi bi-geo-alt"></i> -->
              <i class="fa fa-map-marker" ></i>
                <h4>Location:</h4>
                <p> # 4-16-347/4,4th lane, <br>Pottisriramulu Nagar, Guntur,-522002 </p>
              </div>

              <div class="col-lg-4 info mt-4 mt-lg-0">
               <!--  <i class="bi bi-envelope"></i> -->
               <i class="fa fa-envelope-o"></i>
                <h4>Email:</h4>
                <p>keerthistar12@gmail.com</p>
              </div>

              <div class="col-lg-4 info mt-4 mt-lg-0">
               <!--  <i class="bi bi-phone"></i> -->
               <i class="fa fa-phone" ></i>
                <h4>Call:</h4>
                <p>+91-9553010369</p>
              </div>
            </div>
          </div>
        </div>
      </div>

      <div class="row mt-5 justify-content-center" data-aos="fade-up">
        <div class="col-lg-10">
          <form  id="mail" method="post" role="form" class="php-email-form">

            <div class="row">
              <div class="col-md-6 form-group">
                <input type="text" name="name" class="form-control" id="name" placeholder="Your Name" required>
              </div>

              <div class="col-md-6 form-group mt-3 mt-md-0">
                <input type="email" class="form-control" name="email" id="email" placeholder="Your Email" required>
              </div>
            </div>

            <div class="form-group mt-3">
              <input type="text" class="form-control" name="subject" id="subject" placeholder="Subject" required>
            </div>

            <div class="form-group mt-3">
              <textarea class="form-control" id="massage" name="message" rows="5" placeholder="Message" required></textarea>
            </div>
           
            <div class="text-center"><input type="submit" class="btn btn-success" name="submit" value ="Send Message"></div>
          </form> 
        </div>

      </div>

    </div>
   
  </section><!-- End Contact Section -->