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<!DOCTYPE html>
<html lang="en">
<head>
<meta charset="UTF-8">
<meta name="viewport" content="width=device-width, initial-scale=1.0">
<title>Feedback Form</title>
<style>
body {
font-family: Arial, sans-serif;
font-size: 20px;
line-height: 1.6;
margin: 0;
padding: 0;
background-color: #f2f2f2;
color: #333;
}
header {
background-color: #fff;
padding: 10px 0;
box-shadow: 0 4px 4px rgba(0, 0, 0, 0.1);
text-align: center;
}
.HEADER-image {
width: 100px; /* Adjust width as needed */
height: auto; /* Maintain aspect ratio */
margin-right: 15px;
cursor: pointer;
}
.container {
width: 100%;
max-width: 800px;
margin: 22 auto;
padding: 10px;
box-sizing: border-box;
background-color: #f2f2f2;
color: #333;
}
h1, h2 {
font-weight: bold;
font-size: 24px;
margin-top: 0;
}
.main-content {
display: flex;
flex-direction: column;
align-items: center;
}
input[type="text"], input[type="email"], textarea {
width: 100%;
padding: 12px;
margin-bottom: 20px;
border: 1px solid #ccc;
border-radius: 8px;
box-sizing: border-box;
font-size: 20px;
}
input[type="submit"], .large-button {
display: inline-block;
padding: 12px 24px;
font-size: 20px;
font-weight: bold;
text-decoration: none;
color: #fff;
background-color: #007bff;
border: 2px solid #007bff;
border-radius: 8px;
cursor: pointer;
transition: background-color 0.3s ease;
margin-right: 10px;
}
input[type="submit"]:hover, .large-button:hover {
background-color: #0056b3;
}
footer {
text-align: center;
background-color: #fff;
padding: 20px;
box-shadow: 0 -2px 4px rgba(0, 0, 0, 0.1);
margin-top: 20px;
}
.success-message {
display: none;
color: blue;
font-size: 18px;
margin-top: 20px;
}
.button-container {
text-align: center;
margin-top: 20px;
}
</style>
</head>
<body>
<header>
<a href="https://ameenmarashi-mretinaai.static.hf.space">
<img src="MretinaAILogo.png" alt="Grayscale Example" class="HEADER-image">
</a>
<h1>Feedback Form</h1>
<p>Share your thoughts with us</p>
</header>
<div class="container">
<div class="main-content">
<form id="contact-form">
<label for="name">Your Name:</label>
<input type="text" id="name" name="from_name" required>
<label for="email">Your Email:</label>
<input type="email" id="email" name="reply_to" required>
<label for="feedbackContent">Your Feedback:</label>
<textarea id="feedbackContent" name="message" rows="6" required></textarea>
<div class="button-container">
<input type="submit" value="Submit Feedback">
<button type="button" onclick="clearFields()" class="large-button">Clear</button>
</div>
</form>
<p class="success-message" id="success-message">Feedback sent successfully!</p>
</div>
</div>
<footer>
<p>© 2024 mRetina AI. All rights reserved. Created and designed by Ameen Marashi, M.D.</p>
</footer>
<script type="text/javascript" src="https://cdn.jsdelivr.net/npm/@emailjs/browser@4/dist/email.min.js"></script>
<script type="text/javascript">
(function() {
emailjs.init("fBOjk9QeDO8CPFMwG");
})();
</script>
<script type="text/javascript">
window.onload = function() {
document.getElementById('contact-form').addEventListener('submit', function(event) {
event.preventDefault();
emailjs.sendForm('service_0tpadqt', 'template_a5a6cgp', this)
.then(() => {
document.getElementById('success-message').style.display = 'block';
document.getElementById('contact-form').reset();
}, (error) => {
console.log('FAILED...', error);
});
});
}
function clearFields() {
document.getElementById('name').value = '';
document.getElementById('email').value = '';
document.getElementById('feedbackContent').value = '';
}
</script>
</body>
</html>
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