| <!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; |
| height: auto; |
| 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> |
|
|
