<?php include("header.php"); ?>

<style>

.home-section { 

    padding-top: 138px !important;
    padding-bottom: 50px !important;
}


input.register-input, select.register-input {
    width: 100%!important;
    height: 60px!important;
    padding-left: 3%!important;
    padding-right: 5%!important;
    margin-bottom: 15px!important;
    color: #fff!important;
    border: 2px solid #0387cb;
    background-color: #fff;
    font-size: 16px!important;
    border-radius: 2px !important;
}


input.register-submit {
    background: #0387cb !important;
    border: none;
    color: #fff;
    letter-spacing: 1px;
    cursor: pointer;
    display: inline-block;
    font-size: 14px;
    font-weight: 700;
    width: 100%;
    padding: 20px 0;
    text-transform: uppercase;
    -webkit-border-radius: 3px 3px;
    -moz-border-radius: 3px 3px;
    border-radius: 3px 3px;
    transition: all .50s ease-in-out;
    -moz-transition: all .50s ease-in-out;
    -webkit-transition: all .50s ease-in-out;
}



</style>


    <!--begin home section -->
    <section class="home-section" id="home">

        <div class="home-section-overlay"></div>


		<!--begin container -->
		<div class="container">

	        <!--begin row -->
	        <div class="row">
	          
                <!--begin col-md-6-->
                <div class="col-md-6 margin-top-40 hero-content">




                    <h1>Contact Us</h1>

                    <p class="hero-text">Discover the future of healthcare with Trusted Healthcare Providers.</p>

                    <!--begin newsletter_form_box -->
                    <div class="newsletter_form_box">
                        
                        <!--begin success_box -->
                        <p class="newsletter_success_box" style="display:none;">We received your message and you'll hear from us soon. Thank You!</p>
                        <!--end success_box -->
                        
                        <!--begin newsletter-form -->


                    
                    </div>
                    <!--end newsletter_form_box -->
        
                </div>
                <!--end col-md-6-->

                <!--begin col-md-6-->
                <div class="col-md-6">


                </div>
                <!--end col-md-6-->

	        </div>
	        <!--end row -->

		</div>
		<!--end container -->

    </section>
    <!--end home section -->



    <section class="section-grey" id="contact">
        

        <!--begin container-->
        <div class="container">

            <!--begin row -->
            <div class="row">

                <!--begin col-md-12-->
                <div class="col-md-12 text-center padding-bottom-10">

                    <h3 class="section-title">Get Your Free Consultation</h3>

                    <p class="section-subtitle">Fill out the form and we reach out to you as soon as possible.</b></p>

                </div>
                <!--end col-md-12 -->

            </div>
            <!--end row -->

            <!--begin row-->
            <div class="row justify-content-md-center">
            
                <!--begin col-md-8-->
                <div class="col-md-6 text-center margin-top-10">

                    <!--begin register-form-wrapper-->
                    <div class="register-form-wrapper wow bounceIn" data-wow-delay="0.5s" style="visibility: visible; animation-delay: 0.5s; animation-name: bounceIn;">

                        <!--begin form-->
                        <div>
                             
                            <!--begin success message -->
                            <p class="register_success_box" style="display:none;">We received your message and you will hear from us soon. Thank You!</p>
                            <!--end success message -->
                            
                            <!--begin register form -->
                            <form id="register-form" class="register-form register" action="php/register.php" method="post">
                                
                                    <input class="register-input black-input" required="" name="firstname" placeholder="First Name*" type="text">
                                    <input class="register-input black-input" required="" name="lastname" placeholder="Last Name*" type="text">
                                    <input class="register-input black-input" required="" name="email" placeholder="Telephone Number*" type="email">
                                    <input class="register-input black-input" required="" name="email" placeholder="Email Adress*" type="email">

        
                                    <input value="Start Trial" class="register-submit" type="submit">
                                
                            </form>
                            <!--end register form -->
                            
                            <p class="register-form-terms">THIS IS NOT HEALTH INSURANCE</p>

                        </div>
                        <!--end form-->

                    </div>
                    <!--end register-form-wrapper-->

                </div>
                <!--end col-md-8-->
            
            </div>
            <!--end row-->
    
        </div>
        <!--end container-->
    
    </section>
    <?php include("footer.php"); ?>