shyaf
/
shyaf-resource


			
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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, user-scalable=0, minimum-scale=1.0, maximum-scale=1.0,viewport-fit=cover">
    <title></title>
    <link rel="stylesheet" href="../css/order.css">
    <style>
        body{
            padding: 0.2rem;
        }
        .page .h1{
            color: skyblue;
            font-size: 1rem;
            text-align: center;
        }
        .page .content .h2{
            font-size: 0.16rem;
            padding-left: 1rem;
        }
        .page .content .form{
            border-top: 0.2rem solid skyblue;
            box-shadow: 0 0 2.5rem rgba(75, 86, 101, 0.3);
            margin-top: 0.6rem;
            padding: 0.6rem;
        }
        .page .form .box{
            display: flex;
            margin-left:2rem;
            margin-bottom: 0.4rem;
        }
        .page .form .text{
            width: 5rem;
            display: flex;
            font-size: 0.15rem;
            font-weight: bold;
            margin: auto 0;
        }
        .page .form .text .icon{
            color: red;
        }
        .page .form .box>input{
            width: 7rem;
            height: 1.5rem;
        }
        .page .form .box .code{
            width: 5rem;
        }
        .page .form .box>button{
            border:0.15rem solid skyblue;
            margin-left: 0.8rem;
            background-color: white;
            padding-left: 0.8rem;
            padding-right: 0.8rem;
        }
        .button{
            text-align: center;
            margin-top: 1.5rem;
        }
        .button>button{
            background-color: rgb(34, 165, 218);
            color: white;
            font-size: 0.28rem;
            border: none;
            padding: 0.6rem 2.8rem;
        }
    </style>
</head>
<body>
    <div class="page">
        <p class="h1">IQQA精准术前三维评估及手术规划</p>
        <div class="content">
            <p class="h2">请告诉我们您的手机号码，使我们能够及时通知到您服务的进度。</p>
            <div class="form">
                <p id="warn" style="color: red; display: none;">手机号码必须要填写！</p>
                <div class="box">
                    <div class="text">
                        <p class="icon">*</p>
                        手机号码：
                    </div>
                    <input id="iphone" value="" type="text" maxlength="11" placeholder="手机号码">
                </div>
                <div class="box">
                    <div class="text">
                        <p class="icon">*</p>
                        姓名：
                    </div>
                    <input type="text" placeholder="用户姓名">
                </div>
                <div class="box">
                    <div class="text">
                        <p style="color: white; margin: auto 0;">*</p>
                        验证码：
                    </div>
                    <input class="code" type="text" placeholder="验证码">
                    <button id="button">获取验证码</button>
                </div>
            </div>
            <p style="font-size: 0.16rem;padding-left: 1rem;margin-top: 1.2rem;">请确认病人是否正确，医生在查看报告时，会核对此处的姓名。</p>
            <div class="form">
                <div class="box">
                    <div class="text">
                        <p class="icon">*</p>
                        患者姓名：
                    </div>
                    <input id="iphone" value="" type="text" placeholder="手机号码">
                </div>
                <div class="box">
                    <div class="text">
                        <p style="color: white; margin: auto 0;">*</p>
                        就诊医院：
                    </div>
                    <input style="width: 12rem;" id="" value="" type="text" placeholder="XX医院" disabled>
                </div>
                <div class="box">
                    <div class="text">
                        <p style="color: white; margin: auto 0;">*</p>
                        就诊科室：
                    </div>
                    <input style="width: 8rem;" id="" value="" type="text" placeholder="胸外科">
                </div>
                <div class="box">
                    <div class="text">
                        <p style="color: white; margin: auto 0;">*</p>
                        就诊医生：
                    </div>
                    <input style="width: 8rem;" id="" value="" type="text" placeholder="">
                </div>
                <div class="box">
                    <div class="text">
                        <p style="color: white; margin: auto 0;">*</p>
                        邮寄地址：
                    </div>
                    <input style="width: 8rem;" id="" value="" type="text" placeholder="">
                </div>
            </div>
        </div>
        <div class="button">
            <button>我要购买此服务</button>
        </div>
    </div>
</body>


<script type="text/javascript" src="../js/jquery.min.js"></script>
<script src="../js/distpicker.data.min.js"></script>
<script src="../js/distpicker.min.js"></script>
<script>
</script>
</html>