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@@ -13,8 +13,8 @@
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<div class="container py-5 my-4">
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<div class="row">
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<div class="col-lg-6 bg-grey p-lg-5 p-4 mb-4" style="border-bottom:7px solid var(--pry-color);">
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- <h4 class="subtitle">Get in touch with us:</h4>
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- <p class="mb-4">Send us Message and we will get back to you!</p>
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+ <h4 class="subtitle">Contact us:</h4>
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+ <p class="mb-4">If you have any questions about the Snyder HemBand system, hemorrhoid banding, or anything else, you can contact us anytime. We’ll get back to you shortly!</p>
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<form class="" action="{{ route('submit-contact') }}" method="post">
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@csrf
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<div class="row">
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@@ -31,9 +31,24 @@
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@enderror
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</div>
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</div>
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+ <div class="row">
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+ <div class="col-lg-6 form-group mb-4">
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+ <input type="email" class="form-control rounded-0 py-3" name="email" placeholder="Email Address" value="{{ old('email') }}">
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+ @error('email')
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+ <small class="text-warning">{{$message}}</small>
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+ @enderror
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+ </div>
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+ <div class="col-lg-6 form-group mb-4">
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+ <input type="text" class="form-control rounded-0 py-3" name="phone" placeholder="Phone Number" value="{{ old('phone') }}">
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+ @error('phone')
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+ <small class="text-warning">{{$message}}</small>
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+ @enderror
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+ </div>
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+ </div>
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+
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<div class="form-group mb-4">
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- <input type="email" class="form-control rounded-0 py-3" name="email" placeholder="Email Address" value="{{ old('email') }}">
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- @error('email')
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+ <input type="text" class="form-control rounded-0 py-3" name="zip" placeholder="Zip Code" value="{{ old('zip') }}">
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+ @error('zip')
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<small class="text-warning">{{$message}}</small>
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@enderror
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</div>
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