programari-diaconu.cad.onlineservice.io Open in urlscan Pro
13.39.175.148  Public Scan

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<form method="post" id="form" target="hiddenFrame">
  <!--    <div class="top-info" id="top-info" tabindex="-1" style="width: 100%">-->
  <!---->
  <!--    </div>-->
  <div class="container-fluid" style="padding: 25px 20px">
    <div class="row mb-4">
      <div class="col-md-12">
        <a href="https://clinicadiaconu.ro/"><img style="margin-right: 30px; width: 192px; height: 64px;" src="https://clinicadiaconu.ro/wp-content/uploads/2017/04/logo-diaconu.png"></a>
        <a href="https://clinicadiaconu.ro/" class="btn  back-to-site focus_button"> <i class="fa fa-chevron-left" style="padding-right: 5px"></i>Inapoi  in site</a>
      </div>
    </div>
  </div>
  <div class="container-fluid" id="page1">
    <div class="row mb-4">
      <!--            <div class="col-12">-->
      <!--                <div class="alert alert-danger" role="alert"></div>-->
      <!--            </div>-->
      <div class="form-group col-md-6 col-lg-4">
        <label for="doctor_id"><strong>1. Alege tipul programarii</strong></label>
        <div class="d-flex">
          <div class="custom-control custom-radio">
          </div>
          <div class="custom-control custom-radio">
            <br>
          </div>
        </div>
        <div>
          <div class="dropdown bootstrap-select"><select class="selectpicker" id="appointment_type_id" name="appointment_type_id" tabindex="-98">
              <option selected="selected">Alege</option>
              <!--                                        <option value="1">Consultatie online prin zoom</option>-->
              <!--                                        <option value="2">Consultatie in clinica</option>-->
              <option value="1002">Consultatie Oftalmologie</option>
              <option value="1003">Consultatie Dermatologie</option>
              <option value="1004">Consultatie Chirurgie plastica</option>
            </select><button type="button" class="btn dropdown-toggle btn-light" data-toggle="dropdown" role="combobox" aria-owns="bs-select-1" aria-haspopup="listbox" aria-expanded="false" data-id="appointment_type_id" title="Alege">
              <div class="filter-option">
                <div class="filter-option-inner">
                  <div class="filter-option-inner-inner">Alege</div>
                </div>
              </div>
            </button>
            <div class="dropdown-menu " style="max-height: 961px; overflow: hidden; min-height: 147px;">
              <div class="inner show" role="listbox" id="bs-select-1" tabindex="-1" aria-activedescendant="bs-select-1-0" style="max-height: 959px; overflow-y: auto; min-height: 145px;">
                <ul class="dropdown-menu inner show" role="presentation" style="margin-top: 0px; margin-bottom: 0px;">
                  <li class="selected active"><a role="option" class="dropdown-item active selected" id="bs-select-1-0" tabindex="0" aria-setsize="4" aria-posinset="1" aria-selected="true"><span class="text">Alege</span></a></li>
                  <li><a role="option" class="dropdown-item" id="bs-select-1-1" tabindex="0"><span class="text">Consultatie Oftalmologie</span></a></li>
                  <li><a role="option" class="dropdown-item" id="bs-select-1-2" tabindex="0"><span class="text">Consultatie Dermatologie</span></a></li>
                  <li><a role="option" class="dropdown-item" id="bs-select-1-3" tabindex="0"><span class="text">Consultatie Chirurgie plastica</span></a></li>
                </ul>
              </div>
            </div>
          </div>
        </div>
        <br>
        <div class="dropdown bootstrap-select"><select class="selectpicker" id="doctor_id" name="doctor_id" tabindex="-98">
            <!--                    <option selected>Alege</option>-->
          </select><button type="button" class="btn dropdown-toggle btn-light bs-placeholder" data-toggle="dropdown" role="combobox" aria-owns="bs-select-2" aria-haspopup="listbox" aria-expanded="false" data-id="doctor_id" title="Alege">
            <div class="filter-option">
              <div class="filter-option-inner">
                <div class="filter-option-inner-inner">Alege</div>
              </div>
            </div>
          </button>
          <div class="dropdown-menu ">
            <div class="inner show" role="listbox" id="bs-select-2" tabindex="-1">
              <ul class="dropdown-menu inner show" role="presentation"></ul>
            </div>
          </div>
        </div>
      </div>
      <div class="form-group col-md-6 col-lg-4 custom_mobile">
        <label for="date"><strong>2. Alege data</strong></label>
        <div class="d-flex hide_mobile">
          <div class="custom-control custom-radio">
          </div>
          <div class="custom-control custom-radio">
            <br>
          </div>
        </div>
        <div class="datepicker" name="date">
          <input type="hidden" id="datepicker" name="date1" value="">
          <div class="datepicker datepicker-inline">
            <div class="datepicker-days" style="">
              <table class="table-condensed">
                <thead>
                  <tr>
                    <th colspan="7" class="datepicker-title" style="display: none;"></th>
                  </tr>
                  <tr>
                    <th class="prev disabled">«</th>
                    <th colspan="5" class="datepicker-switch">Aprilie 2023</th>
                    <th class="next">»</th>
                  </tr>
                  <tr>
                    <th class="dow">Lu</th>
                    <th class="dow">Ma</th>
                    <th class="dow">Mi</th>
                    <th class="dow">Jo</th>
                    <th class="dow">Vi</th>
                    <th class="dow disabled">Sâ</th>
                    <th class="dow">Du</th>
                  </tr>
                </thead>
                <tbody>
                  <tr>
                    <td class="old disabled day disabled" data-date="1679875200000">27</td>
                    <td class="old disabled day disabled" data-date="1679961600000">28</td>
                    <td class="old disabled day disabled" data-date="1680048000000">29</td>
                    <td class="old disabled day disabled" data-date="1680134400000">30</td>
                    <td class="old disabled day disabled" data-date="1680220800000">31</td>
                    <td class="disabled disabled-date day disabled" data-date="1680307200000">1</td>
                    <td class="disabled disabled-date day disabled" data-date="1680393600000">2</td>
                  </tr>
                  <tr>
                    <td class="disabled day disabled" data-date="1680480000000">3</td>
                    <td class="disabled day disabled" data-date="1680566400000">4</td>
                    <td class="disabled day disabled" data-date="1680652800000">5</td>
                    <td class="disabled day disabled" data-date="1680739200000">6</td>
                    <td class="disabled day disabled" data-date="1680825600000">7</td>
                    <td class="disabled disabled-date day disabled" data-date="1680912000000">8</td>
                    <td class="disabled disabled-date day disabled" data-date="1680998400000">9</td>
                  </tr>
                  <tr>
                    <td class="disabled day disabled" data-date="1681084800000">10</td>
                    <td class="disabled day disabled" data-date="1681171200000">11</td>
                    <td class="disabled day disabled" data-date="1681257600000">12</td>
                    <td class="disabled day disabled" data-date="1681344000000">13</td>
                    <td class="disabled day disabled" data-date="1681430400000">14</td>
                    <td class="disabled disabled-date day disabled" data-date="1681516800000">15</td>
                    <td class="disabled disabled-date day disabled" data-date="1681603200000">16</td>
                  </tr>
                  <tr>
                    <td class="disabled day disabled" data-date="1681689600000">17</td>
                    <td class="disabled day disabled" data-date="1681776000000">18</td>
                    <td class="disabled day disabled" data-date="1681862400000">19</td>
                    <td class="disabled day disabled" data-date="1681948800000">20</td>
                    <td class="disabled day disabled" data-date="1682035200000">21</td>
                    <td class="disabled disabled-date day disabled" data-date="1682121600000">22</td>
                    <td class="disabled disabled-date day disabled" data-date="1682208000000">23</td>
                  </tr>
                  <tr>
                    <td class="disabled day disabled" data-date="1682294400000">24</td>
                    <td class="disabled day disabled" data-date="1682380800000">25</td>
                    <td class="today day disabled" data-date="1682467200000">26</td>
                    <td class="day disabled" data-date="1682553600000">27</td>
                    <td class="day disabled" data-date="1682640000000">28</td>
                    <td class="disabled disabled-date day disabled" data-date="1682726400000">29</td>
                    <td class="disabled disabled-date day disabled" data-date="1682812800000">30</td>
                  </tr>
                  <tr>
                    <td class="new day disabled" data-date="1682899200000">1</td>
                    <td class="new day disabled" data-date="1682985600000">2</td>
                    <td class="new day disabled" data-date="1683072000000">3</td>
                    <td class="new day disabled" data-date="1683158400000">4</td>
                    <td class="new day disabled" data-date="1683244800000">5</td>
                    <td class="new disabled disabled-date day disabled" data-date="1683331200000">6</td>
                    <td class="new disabled disabled-date day disabled" data-date="1683417600000">7</td>
                  </tr>
                </tbody>
                <tfoot>
                  <tr>
                    <th colspan="7" class="today" style="display: none;">Astăzi</th>
                  </tr>
                  <tr>
                    <th colspan="7" class="clear" style="display: none;">Șterge</th>
                  </tr>
                </tfoot>
              </table>
            </div>
            <div class="datepicker-months" style="display: none;">
              <table class="table-condensed">
                <thead>
                  <tr>
                    <th colspan="7" class="datepicker-title" style="display: none;"></th>
                  </tr>
                  <tr>
                    <th class="prev disabled">«</th>
                    <th colspan="5" class="datepicker-switch">2023</th>
                    <th class="next">»</th>
                  </tr>
                </thead>
                <tbody>
                  <tr>
                    <td colspan="7"><span class="month disabled">Ian</span><span class="month disabled">Feb</span><span class="month disabled">Mar</span><span class="month focused">Apr</span><span class="month">Mai</span><span
                        class="month">Iun</span><span class="month">Iul</span><span class="month">Aug</span><span class="month">Sep</span><span class="month">Oct</span><span class="month">Nov</span><span class="month">Dec</span></td>
                  </tr>
                </tbody>
                <tfoot>
                  <tr>
                    <th colspan="7" class="today" style="display: none;">Astăzi</th>
                  </tr>
                  <tr>
                    <th colspan="7" class="clear" style="display: none;">Șterge</th>
                  </tr>
                </tfoot>
              </table>
            </div>
            <div class="datepicker-years" style="display: none;">
              <table class="table-condensed">
                <thead>
                  <tr>
                    <th colspan="7" class="datepicker-title" style="display: none;"></th>
                  </tr>
                  <tr>
                    <th class="prev disabled">«</th>
                    <th colspan="5" class="datepicker-switch">2020-2029</th>
                    <th class="next">»</th>
                  </tr>
                </thead>
                <tbody>
                  <tr>
                    <td colspan="7"><span class="year old disabled">2019</span><span class="year disabled">2020</span><span class="year disabled">2021</span><span class="year disabled">2022</span><span class="year focused">2023</span><span
                        class="year">2024</span><span class="year">2025</span><span class="year">2026</span><span class="year">2027</span><span class="year">2028</span><span class="year">2029</span><span class="year new">2030</span></td>
                  </tr>
                </tbody>
                <tfoot>
                  <tr>
                    <th colspan="7" class="today" style="display: none;">Astăzi</th>
                  </tr>
                  <tr>
                    <th colspan="7" class="clear" style="display: none;">Șterge</th>
                  </tr>
                </tfoot>
              </table>
            </div>
            <div class="datepicker-decades" style="display: none;">
              <table class="table-condensed">
                <thead>
                  <tr>
                    <th colspan="7" class="datepicker-title" style="display: none;"></th>
                  </tr>
                  <tr>
                    <th class="prev disabled">«</th>
                    <th colspan="5" class="datepicker-switch">2000-2090</th>
                    <th class="next">»</th>
                  </tr>
                </thead>
                <tbody>
                  <tr>
                    <td colspan="7"><span class="decade old disabled">1990</span><span class="decade disabled">2000</span><span class="decade disabled">2010</span><span class="decade disabled focused">2020</span><span class="decade">2030</span><span
                        class="decade">2040</span><span class="decade">2050</span><span class="decade">2060</span><span class="decade">2070</span><span class="decade">2080</span><span class="decade">2090</span><span class="decade new">2100</span>
                    </td>
                  </tr>
                </tbody>
                <tfoot>
                  <tr>
                    <th colspan="7" class="today" style="display: none;">Astăzi</th>
                  </tr>
                  <tr>
                    <th colspan="7" class="clear" style="display: none;">Șterge</th>
                  </tr>
                </tfoot>
              </table>
            </div>
            <div class="datepicker-centuries" style="display: none;">
              <table class="table-condensed">
                <thead>
                  <tr>
                    <th colspan="7" class="datepicker-title" style="display: none;"></th>
                  </tr>
                  <tr>
                    <th class="prev disabled">«</th>
                    <th colspan="5" class="datepicker-switch">2000-2900</th>
                    <th class="next">»</th>
                  </tr>
                </thead>
                <tbody>
                  <tr>
                    <td colspan="7"><span class="century old disabled">1900</span><span class="century disabled focused">2000</span><span class="century">2100</span><span class="century">2200</span><span class="century">2300</span><span
                        class="century">2400</span><span class="century">2500</span><span class="century">2600</span><span class="century">2700</span><span class="century">2800</span><span class="century">2900</span><span
                        class="century new">3000</span></td>
                  </tr>
                </tbody>
                <tfoot>
                  <tr>
                    <th colspan="7" class="today" style="display: none;">Astăzi</th>
                  </tr>
                  <tr>
                    <th colspan="7" class="clear" style="display: none;">Șterge</th>
                  </tr>
                </tfoot>
              </table>
            </div>
          </div>
        </div>
      </div>
      <div class="form-group col-md-6 col-lg-4 custom_mobile">
        <label for="hour"><strong>3. Alege ora</strong></label>
        <input type="hidden" name="hour" id="hour" value="">
        <!--                <input type="hidden" name="doctor_id" id="doctor_id">-->
        <div class="d-flex hide_mobile">
          <div class="custom-control custom-radio">
          </div>
          <div class="custom-control custom-radio">
            <br>
          </div>
        </div>
        <!--                <select class="selectpicker" id="hour" name="hour">-->
        <!--                    <!--                    <option selected>Alege</option>-->
        <!--                </select>-->
        <div id="doctor_time" class="btn-group-toggle" data-toggle="buttons">
        </div>
      </div>
    </div>
    <div class="bottom-info row">
      <div id="doctor_info" class="col-md-4 col-sm-12">
        <strong></strong>
      </div>
      <div id="data_info" class="col-md-4 col-sm-12"></div>
      <input id="info_data" type="hidden" name="info_data">
      <div style="text-align: center" class="col-md-4 col-sm-12">
        <div id="price_info" align="center"></div>
        <button type="button" id="button1" class="btn focus_button">Pasul urmator</button>
      </div>
    </div>
  </div>
  <div class="container-fluid" id="page2" style="display: none">
    <h2>Date personale</h2>
    <div class="row mb-4">
      <div class="col-12">
        <div class="alert alert-danger" role="alert" style="display: none;">
          <strong>Programarea nu a putut fi salvata</strong> Va rugam reincercati!
        </div>
      </div>
      <div class="form-group col-md-3">
        <label for="surname">Prenume</label>
        <input type="text" class="form-control" id="surname" name="surname">
      </div>
      <div class="form-group col-md-3">
        <label for="name">Nume</label>
        <input type="text" class="form-control" id="name" name="name">
      </div>
      <div class="form-group col-md-6">
        <label for="email">Email</label>
        <input type="email" class="form-control" id="email" name="email">
      </div>
      <div class="form-group col-md-6">
        <label for="phone">Telefon</label>
        <input type="tel" class="form-control" id="phone" name="phone">
      </div>
      <div class="form-group col-md-6">
        <label for="birthday">Data nasterii (ZZ/LL/AAAA)</label>
        <input type="text" class=" form-control" id="birthday" name="birthday" data-inputmask="'alias': 'date'">
      </div>
      <div class="form-group col-12">
      </div>
      <div class="form-group col-md-7">
        <label for="gdpr" class="checkbox-container pull-left"> Sunt de acord cu <a href="https://clinicadiaconu.ro/protectia-datelor" target="_blank"> Politica de confidentialitate</a>
          <input type="checkbox" id="gdpr" name="gdpr">
          <span class="checkmark"></span>
        </label>
      </div>
    </div>
    <div class="bottom-info row">
      <div id="doctor_info1" class="col-md-4 col-sm-12">
        <strong></strong>
      </div>
      <div id="data_info1" class="col-md-4 col-sm-12"></div>
      <div class="col-md-4 col-sm-12" style="text-align: center">
        <div id="price_info1" align="center"></div>
        <button type="submit" id="button2" class="btn focus_button">SALVEAZA PROGRAMARE</button>
      </div>
    </div>
  </div>
  <div class="container-fluid" role="alert" id="page3" style="display: none">
    <div class="row mb-4" style="height: 350px">
      <div style="margin-top: 150px; margin-left: 100px" align="center">
        <center>
          <h1 style="color: darkseagreen" align="center"><strong>Programarea a fost înregistrată cu succes, ai confirmarea pe email.<br> Mulțumim pentru încredere!</strong></h1>
        </center>
      </div>
    </div>
    <div class="bottom-info">
      <div id="doctor_info2">
        <strong></strong>
      </div>
      <div id="data_info2"></div>
      <div>
        <div id="price_info2" align="center"></div>
        <!--                <a type="button" href="https://www.clario.ro/" target="_self" class="btn btn-primary">Inapoi la site</a>-->
      </div>
    </div>
  </div>
</form>

Text Content

Inapoi in site
1. Alege tipul programarii


Alege Consultatie OftalmologieConsultatie DermatologieConsultatie Chirurgie
plastica
Alege
 * Alege
 * Consultatie Oftalmologie
 * Consultatie Dermatologie
 * Consultatie Chirurgie plastica


Alege

2. Alege data



«Aprilie
2023»LuMaMiJoViSâDu27282930311234567891011121314151617181920212223242526272829301234567AstăziȘterge

«2023»IanFebMarAprMaiIunIulAugSepOctNovDecAstăziȘterge

«2020-2029»201920202021202220232024202520262027202820292030AstăziȘterge

«2000-2090»199020002010202020302040205020602070208020902100AstăziȘterge

«2000-2900»190020002100220023002400250026002700280029003000AstăziȘterge

3. Alege ora




Pasul urmator


DATE PERSONALE

Programarea nu a putut fi salvata Va rugam reincercati!
Prenume
Nume
Email
Telefon
Data nasterii (ZZ/LL/AAAA)

Sunt de acord cu Politica de confidentialitate

SALVEAZA PROGRAMARE


PROGRAMAREA A FOST ÎNREGISTRATĂ CU SUCCES, AI CONFIRMAREA PE EMAIL.
MULȚUMIM PENTRU ÎNCREDERE!


 * 
 * Consultatia se va face in clinica si va fi tinuta de un medic oftalmolog
   Clinica Dr. Diaconu.
 *