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