<?php
/**
 * The home template file
 *
 * This is the most generic template file in a WordPress theme and one
 * of the two required files for a theme (the other being style.css).
 * It is used to display a page when nothing more specific matches a query,
 * e.g., it puts together the home page when no home.php file exists.
 *
 * Template Name: Script
 *
 */

?>
<?php get_header();?>

<div id="diagnosticare">

  <div id="mouth">
    <div id="mapster_wrap_0" style="display: block; position: relative; padding: 0px; width: 325px; height: 458px;"><img
        src="<?php echo get_template_directory_uri() . '/images/general/mouth.jpg'; ?>" class="mapster_el"
        style="border: 0px; position: absolute; left: 0px; top: 0px; padding: 0px; opacity: 1;"><canvas width="325"
        height="458" class="mapster_el"
        style="position: absolute; left: 0px; top: 0px; padding: 0px; border: 0px;"></canvas><canvas width="325"
        height="458" class="mapster_el"
        style="position: absolute; left: 0px; top: 0px; padding: 0px; border: 0px; opacity: 1;"></canvas><img
        id="mouthMap" src="<?php echo get_template_directory_uri() . '/images/general/mouth.jpg'; ?>" width="325" height="458" border="0"
        usemap="#Map" style="border: 0px; position: absolute; left: 0px; top: 0px; padding: 0px; opacity: 0;"></div>
    <map name="Map" id="Map">

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        href="#" alt="28" title="28">

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        href="#" alt="32" title="32">
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        href="#" alt="38" title="38">

      <!--DINTII DE LA 41 la 48 -->

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        href="#" alt="48" title="48">
    </map>

  </div>
  <!-- <form action="http://dev5.sicomedia.ro/front/save_reservation" method="post" accept-charset="utf-8" -->
    <form action="" method="post" accept-charset="utf-8" id="form_reservation">
    <div id="step_one">

      <div id="popup">

        <input type="hidden" name="teeth-info" value="">
        <h3>Selectati caracteristicile corespunzatoare</h3>
        <h3>Acest dinte exista ?</h3>
        <div>
              <input type="radio" name="dinte" value="1" /> Da
              <input type="radio" name="dinte" value="0" /> Nu
              <input type="radio" name="dinte" value="2" /> Lucrare/Implant
              </div>
        <div id="questions">
        </div>
        <div>
          <input type="submit" id="salveaza" value="Salveaza selectia">
          <input type="reset" id="inchide" value="Inchide">
        </div>

      </div>

      <div id="indicator" class="inactiv">1</div>
      <!--Are si clasa "activ"-->

      <div id="step_one_info">&nbsp;</div>

      <div id="step_one_selection" style="height: 440px;">
        <div id="scrollbar" style="width: 243px; height: 440px; margin-right: 3px;">
          <div class="content" style="width: 243px; top: 0px;">

            <ul>
            </ul>

          </div>
        </div>
        <div class="scrollbar vertical" style="width: 3px; display: none;">
          <div class="back"
            style="width: 3px; height: 440px; background-color: rgb(173, 175, 174); border-radius: 5px;"></div>
          <div class="dragger" style="top: 0px; width: 7px; background-color: rgb(102, 102, 102); border-radius: 5px;">
          </div>
        </div>
      </div>




      <div class="empty_text">&lt; Selectati un dinte &gt;</div>

    </div>


    <div id="steps_tt">

      <div id="step_two">
        <div id="indicator" class="inactiv">2</div>
        <!--Are si clasa "activ"-->
        <div id="step_two_info">Detalii despre dumneavoastra</div>


        <div id="step_two_form">
          <input name="nume" type="text" class="large text validate[required]" value="Nume" style="margin-top:9px;"
            onclick="if(this.value=='Nume'){this.value=''}" onblur="if(this.value==''){this.value='Nume'}" id="req">

          <span class="birth_input">

            <div class="selector" id="uniform-undefined"><span> Anul nasterii.. </span><select name="an_nastere"
                style="opacity: 0;">
                <option> Anul nasterii.. </option>
                <option value="2011">2011</option>
                <option value="2010">2010</option>
                <option value="2009">2009</option>
                <option value="2008">2008</option>
                <option value="2007">2007</option>
                <option value="2006">2006</option>
                <option value="2005">2005</option>
                <option value="2004">2004</option>
                <option value="2003">2003</option>
                <option value="2002">2002</option>
                <option value="2001">2001</option>
                <option value="2000">2000</option>
                <option value="1999">1999</option>
                <option value="1998">1998</option>
                <option value="1997">1997</option>
                <option value="1996">1996</option>
                <option value="1995">1995</option>
                <option value="1994">1994</option>
                <option value="1993">1993</option>
                <option value="1992">1992</option>
                <option value="1991">1991</option>
                <option value="1990">1990</option>
                <option value="1989">1989</option>
                <option value="1988">1988</option>
                <option value="1987">1987</option>
                <option value="1986">1986</option>
                <option value="1985">1985</option>
                <option value="1984">1984</option>
                <option value="1983">1983</option>
                <option value="1982">1982</option>
                <option value="1981">1981</option>
                <option value="1980">1980</option>
                <option value="1979">1979</option>
                <option value="1978">1978</option>
                <option value="1977">1977</option>
                <option value="1976">1976</option>
                <option value="1975">1975</option>
                <option value="1974">1974</option>
                <option value="1973">1973</option>
                <option value="1972">1972</option>
                <option value="1971">1971</option>
                <option value="1970">1970</option>
                <option value="1969">1969</option>
                <option value="1968">1968</option>
                <option value="1967">1967</option>
                <option value="1966">1966</option>
                <option value="1965">1965</option>
                <option value="1964">1964</option>
                <option value="1963">1963</option>
                <option value="1962">1962</option>
                <option value="1961">1961</option>
                <option value="1960">1960</option>
                <option value="1959">1959</option>
                <option value="1958">1958</option>
                <option value="1957">1957</option>
                <option value="1956">1956</option>
                <option value="1955">1955</option>
                <option value="1954">1954</option>
                <option value="1953">1953</option>
                <option value="1952">1952</option>
                <option value="1951">1951</option>
                <option value="1950">1950</option>
                <option value="1949">1949</option>
                <option value="1948">1948</option>
                <option value="1947">1947</option>
                <option value="1946">1946</option>
                <option value="1945">1945</option>
                <option value="1944">1944</option>
                <option value="1943">1943</option>
                <option value="1942">1942</option>
                <option value="1941">1941</option>
                <option value="1940">1940</option>
                <option value="1939">1939</option>
                <option value="1938">1938</option>
                <option value="1937">1937</option>
                <option value="1936">1936</option>
                <option value="1935">1935</option>
                <option value="1934">1934</option>
                <option value="1933">1933</option>
                <option value="1932">1932</option>
                <option value="1931">1931</option>
                <option value="1930">1930</option>
                <option value="1929">1929</option>
                <option value="1928">1928</option>
                <option value="1927">1927</option>
                <option value="1926">1926</option>
                <option value="1925">1925</option>
                <option value="1924">1924</option>
                <option value="1923">1923</option>
                <option value="1922">1922</option>
                <option value="1921">1921</option>
                <option value="1920">1920</option>
                <option value="1919">1919</option>
                <option value="1918">1918</option>
                <option value="1917">1917</option>
                <option value="1916">1916</option>
                <option value="1915">1915</option>
                <option value="1914">1914</option>
                <option value="1913">1913</option>
                <option value="1912">1912</option>
                <option value="1911">1911</option>
                <option value="1910">1910</option>
                <option value="1909">1909</option>
                <option value="1908">1908</option>
                <option value="1907">1907</option>
                <option value="1906">1906</option>
                <option value="1905">1905</option>
                <option value="1904">1904</option>
                <option value="1903">1903</option>
                <option value="1902">1902</option>
                <option value="1901">1901</option>
                <option value="1900">1900</option>
              </select></div>

            <span class="small_select">
              <div class="selector" id="uniform-undefined"><span>Luna..</span><select name="luna_nastere"
                  style="opacity: 0;">
                  <option>Luna..</option>
                  <option value="1">Ianuarie</option>
                  <option value="2">Februarie</option>
                  <option value="3">Martie</option>
                  <option value="4">Aprilie</option>
                  <option value="5">Mai</option>
                  <option value="6">Iunie</option>
                  <option value="7">Iulie</option>
                  <option value="8">August</option>
                  <option value="9">Septembrie</option>
                  <option value="10">Octombrie</option>
                  <option value="11">Noiembrie</option>
                  <option value="12">Decembrie</option>
                </select></div>

              <div class="selector" id="uniform-undefined"><span>Ziua..</span><select name="zi_nastere"
                  style="opacity: 0;">
                  <option>Ziua..</option>
                  <option value="1">1</option>
                  <option value="2">2</option>
                  <option value="3">3</option>
                  <option value="4">4</option>
                  <option value="5">5</option>
                  <option value="6">6</option>
                  <option value="7">7</option>
                  <option value="8">8</option>
                  <option value="9">9</option>
                  <option value="10">10</option>
                  <option value="11">11</option>
                  <option value="12">12</option>
                  <option value="13">13</option>
                  <option value="14">14</option>
                  <option value="15">15</option>
                  <option value="16">16</option>
                  <option value="17">17</option>
                  <option value="18">18</option>
                  <option value="19">19</option>
                  <option value="20">20</option>
                  <option value="21">21</option>
                  <option value="22">22</option>
                  <option value="23">23</option>
                  <option value="24">24</option>
                  <option value="25">25</option>
                  <option value="26">26</option>
                  <option value="27">27</option>
                  <option value="28">28</option>
                  <option value="29">29</option>
                  <option value="30">30</option>
                  <option value="31">31</option>
                </select></div>
            </span>
          </span>


          <div class="selector" id="uniform-judet"><span>Judet de domiciliu..</span><select name="judet" id="judet"
              class="small" style="opacity: 0;">
              <option value="">Judet de domiciliu..</option>
              <option value="Alba">Alba</option>
              <option value="Arad">Arad</option>
              <option value="Arges">Arges</option>
              <option value="Bacau">Bacau</option>
              <option value="Bihor">Bihor</option>
              <option value="Bistrita nasaud">Bistrita Nasaud</option>
              <option value="Botosani">Botosani</option>
              <option value="Braila">Braila</option>
              <option value="Brasov">Brasov</option>
              <option value="Bucuresti">Bucuresti</option>
              <option value="Buzau">Buzau</option>
              <option value="Calarasi">Calarasi</option>
              <option value="Caras severin">Caras Severin</option>
              <option value="Cluj">Cluj</option>
              <option value="Constanta">Constanta</option>
              <option value="Covasna">Covasna</option>
              <option value="Dambovita">Dambovita</option>
              <option value="Dolj">Dolj</option>
              <option value="Galati">Galati</option>
              <option value="Giurgiu">Giurgiu</option>
              <option value="Gorj">Gorj</option>
              <option value="Harghita">Harghita</option>
              <option value="Hunedoara">Hunedoara</option>
              <option value="Ialomita">Ialomita</option>
              <option value="Iasi">Iasi</option>
              <option value="Ilfov">Ilfov</option>
              <option value="Maramures">Maramures</option>
              <option value="Mehedinti">Mehedinti</option>
              <option value="Mures">Mures</option>
              <option value="Neamt">Neamt</option>
              <option value="Olt">Olt</option>
              <option value="Prahova">Prahova</option>
              <option value="Salaj">Salaj</option>
              <option value="Satu mare">Satu Mare</option>
              <option value="Sibiu">Sibiu</option>
              <option value="Suceava">Suceava</option>
              <option value="Teleorman">Teleorman</option>
              <option value="Timis">Timis</option>
              <option value="Tulcea">Tulcea</option>
              <option value="Valcea">Valcea</option>
              <option value="Vaslui">Vaslui</option>
              <option value="Vrancea">Vrancea</option>
              <option value="Other">Alta tara</option>
            </select></div>


          <div class="selector" id="uniform-oras"><span>Oras de domiciliu..</span><select name="oras" id="oras"
              class="small" style="opacity: 0;">
              <option value="">Oras de domiciliu..</option>
            </select></div>

          <input name="email" type="text" class="medium text validate[required, custom[email]]" value="Email"
            style="margin-bottom:0px;" onclick="if(this.value=='Email'){this.value=''}"
            onblur="if(this.value==''){this.value='Email'}" id="email">

          <span style="display:block; float:left; margin-right:5px;">
            <input name="telefon" type="text" class="medium text validate[required,number]" value="Telefon"
              onclick="if(this.value=='Telefon'){this.value=''}" onblur="if(this.value==''){this.value='Telefon'}"
              id="telefon">
          </span>



        </div>

      </div>


      <div id="step_three">
        <div id="indicator" class="inactiv" style="line-height:31px;">3</div>
        <!--Are si clasa "activ"-->
        <div id="step_two_info">Alegeti data si ora consultatiei</div>
        <div class="step-two-inner" style="float:left; padding-top:18px;">
          <div style="margin-top:-2px; margin-left:5px; float:left">
            <div class="selector" id="uniform-intervals"><span>Interval orar..</span><select name="interval"
                id="intervals" style="opacity: 0;">
                <option value="0">Interval orar..</option>
                <option value="08:00">08:00</option>
                <option value="08:30">08:30</option>
                <option value="09:00">09:00</option>
                <option value="09:30">09:30</option>
                <option value="10:00">10:00</option>
                <option value="10:30">10:30</option>
                <option value="11:00">11:00</option>
                <option value="11:30">11:30</option>
                <option value="12:00">12:00</option>
                <option value="12:30">12:30</option>
                <option value="13:00">13:00</option>
                <option value="13:30">13:30</option>
                <option value="14:00">14:00</option>
                <option value="14:30">14:30</option>
                <option value="15:00">15:00</option>
                <option value="15:30">15:30</option>
                <option value="16:00">16:00</option>
                <option value="16:30">16:30</option>
                <option value="17:00">17:00</option>
                <option value="17:30">17:30</option>
                <option value="18:00">18:00</option>
                <option value="18:30">18:30</option>
                <option value="19:00">19:00</option>
                <option value="19:30">19:30</option>
                <option value="20:00">20:00</option>
              </select></div>
          </div>
          <div style="float:left;"><input name="data" type="text" class="medium text hasDatepicker" value="Data.."
              onclick="if(this.value=='Data..'){this.value=''}" onblur="if(this.value==''){this.value='Data..'}"
              style="float:left; margin:0px;" id="dp1554037398058"></div>


          <br>
          <div style="float:right; margin-right:9px; margin-top:2px;">
            <div class="selector disabled" id="uniform-doctors"><span>Doctor/Cabinet</span><select name="doctor"
                id="doctors" disabled="disabled" style="opacity: 0;">
                <option value="0">Doctor/Cabinet</option>
              </select></div>
          </div><br>
          <hr style="margin-top:22px;">
          <!-- <div class="captcha" style="float:left; padding-top:11px">
            <label style="margin-bottom:5px; float:left; font-size:10px;" for="captchaAnswer">Raspunsul corect din
              imagine</label><br>
            <div style="float:left;"><img src="http://dev5.sicomedia.ro/assets/plugins/captcha/image.php"
                alt="Click pentru a incarca alt calcul" title="Click pentru a incarca alt calcul" id="captcha"
                style="border:1px solid #CCC; -webkit-border-radius: 4px; -moz-border-radius: 4px; border-radius: 4px;">
            </div>
            <div style="float:left; margin-top:5px; clear:left;"><input type="text" name="secure" value=""
                style=" margin:0px; width:142px;" id="captchaAnswer"
                class="validate[required, onlyNumber, ajax[ajaxUserCall]] text"></div> -->
          </div>

          <div class="tos" style="float:right; width:167px;">
            <input type="checkbox" name="tos" value="1" class="validate[required]" id="tos">
            <p style="font-size:10px; padding-top:12px; margin-left:22px; line-height:15px;">Am citit si sunt de acord
              cu termenii si conditiile HEALTHIS.</p>
          </div>

          <div style="float:left; margin-left:40px; margin-top:12px;"><input type="submit" name="btnSubmit"
              value="Trimite" id="btnSubmit"></div>
        </div>
      </div>


    </div>
  </form>
</div>

<?php get_footer();?>