File: //home/hurlinghamclinic.co.uk/public_html/booking.php
<?php include ($_SERVER["DOCUMENT_ROOT"] . '/includes/booking-form-code.php'); ?>
<!DOCTYPE html>
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</noscript>
<meta charset="UTF-8" />
<!-- InstanceBeginEditable name="doctitle" -->
<title>Book a consultation</title>
<style>
#wnb-form {
border: 1px solid #c3deea;
background: #fcfcfc;
width: 100%;
position: relative;
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.wnb-input {
width: 274px;
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.row .field span {
font-size: 11px;
left: 0;
position: absolute;
top: 16px;
}
textarea {
height: 100px !important;
}
.wnb-day {
width: 44px;
}
.wnb-date {
background-color: #FFFFFF;
border: 4px solid #DDEEF5;
float: left;
font-size: 14px;
height: 24px;
margin-top: 0;
text-align: center;
line-height: 26px;
}
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cursor: pointer;
}
#book-message, #book-loading, #book-message-success{
position: absolute;
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width: 634px;
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text-align: center;
font-size: 24px;
color: #666666;
/**/display: none;
z-index: 10001;
opacity: 1;
}
#book-message table, #book-message-success table{
width: 100%;
height: 100%;
}
#book-message table td, #book-message-success table td{
vertical-align: middle;
line-height: 34px;
}
#book-loading{
background-color: #FFFFFF;
}
#book-loading div.book-lb, #book-loading div.book-ls{
position: absolute;
top: 0px;
left: 0px;
width: 100%;
}
#book-loading div.book-lb{
padding-top: 54px;
height: 32px;
background: url('../images/ajax-loader.gif') center bottom no-repeat;
}
#book-loading div.book-ls{
padding-top: 105px;
}
</style>
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<style>
#map { height:250px; width:100%;}
#map-canvas {
margin-top:10px;
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.menu_simple img {padding-bottom:20px;}
</style>
</head>
<body class="page page-id-111 page-child parent-pageid-107 page-template page-template-page-article-treatment-php">
<div id="bg-top"></div>
<div id="page" class="hfeed">
<div id="header">
<div id="nav_menu"> </div>
<div style="clear: both"></div>
<div id="main_menu">
<aside id="dc_jqmegamenu_widget-3" class="widget ">
<div class="dcjq-mega-menu" id="dc_jqmegamenu_widget-3-item">
<ul id="menu-main-menu" class="menu">
<li id="menu-item-83" class="menu-item menu-item-type-custom menu-item-object-custom menu-item-83"><a href="/laser-eye-treatment.php">TREATMENTS</a></li>
<li id="menu-item-126" class="menu-item menu-item-type-post_type menu-item-object-page menu-item-126"><a href="short-sighted-treatment.php">SHORT SIGHTED</a></li>
<li id="menu-item-106" class="menu-item menu-item-type-custom menu-item-object-custom current-menu-item menu-item-106"><a href="/long-sightedness.php">LONG SIGHTED</a></li>
<li id="menu-item-127" class="menu-item menu-item-type-post_type menu-item-object-page menu-item-127"><a href="/vision-correction-pricing.php">PRICES</a></li>
<li id="menu-item-4029" class="menu-item menu-item-type-post_type menu-item-object-page menu-item-4029"><a href="/individual-patient-care.php">PATIENT CARE</a></li>
<li id="menu-item-2272" class="menu-item menu-item-type-post_type menu-item-object-page menu-item-2272"><a href="/results.php">RESULTS</a></li>
<li id="menu-item-179" class="menu-item menu-item-type-post_type menu-item-object-page menu-item-179"><a href="/booking.php">BOOK NOW</a></li>
<li id="menu-item-133" class="menu-item menu-item-type-custom menu-item-object-custom menu-item-133"><a href="/about.php">ABOUT</a></li>
<li id="menu-item-474" class="menu-item menu-item-type-post_type menu-item-object-page menu-item-474"><a href="/contact-us.php">CONTACT</a></li>
</ul>
</div>
</aside>
<div style="clear: both"></div>
</div>
<div style="clear: both"></div>
</div>
<!-- #branding -->
<div id="main">
<div id="breadcrumbs"> </div>
<div id="primary">
<div id="content">
<div class="content">
<div class="container bg2">
<div id="vc-content"><!-- InstanceBeginEditable name="EditRegion1" -->
<h1>Book a Free Consultation<br>
</h1>
<p> The Hurlingham Eye Clinic has achieved a 100% success rate for 20/20 vision from our advanced LASIK treatment for typical short-sighted prescriptions (up to -8.00 short-sight and up to 2 dioptres of astigmatism, binocular vision). Compare that 100% to other clinics.</p>
<p> Our consultations are free and with no obligation on your part. You’ll get to meet our team, have a detailed and meticulous test and overview of your eyes and we can then decide whether you are suitable for surgery.</p>
<p> Simply book a free consultation for yourself using the form below.</p>
<div id="wnb-form">
<form name="book" method="POST" action="<?php echo htmlentities($_SERVER['PHP_SELF']); ?>">
<div style="padding: 22px 28px 15px 40px">
<div class="row">
<div class="field"><?php
if(!empty($form_errors)){
echo "<p class='err'>".nl2br($form_errors)."</p>";
}
?></div>
</div>
<div class="row">
<div class="field">Referral Code<br><span style="text-transform: none">If available</span></div>
<div class="field2"><input id="wnb_promo" class="wnb-input" name="promo" value="" type="text"></div>
<div style="clear: both"></div>
</div>
<div class="row">
<div class="field">Title</div>
<div class="field2"><input value="" id="wnb_title" class="wnb-input" name="title" type="text"></div>
<div style="clear: both"></div>
</div>
<div class="row">
<div class="field">First Name</div>
<div class="field2"><input value="" id="wnb_firstname" class="wnb-input" name="firstname" type="text"></div>
<div style="clear: both"></div>
</div>
<div class="row">
<div class="field">Last Name</div>
<div class="field2"><input value="" id="wnb_lastname" class="wnb-input" name="lastname" type="text"></div>
<div style="clear: both"></div>
</div>
<!--
<div class="row">
<div class="field">Date of Birth</div>
<div style="float: right">
<div class="wnb-date wnb-day ddl">
<span>16</span>
<ul style="width: 44px; display: none">
<li>1</li><li>2</li><li>3</li><li>4</li><li>5</li><li>6</li><li>7</li><li>8</li><li>9</li><li>10</li><li>11</li><li>12</li><li>13</li><li>14</li><li>15</li><li>16</li><li>17</li><li>18</li><li>19</li><li>20</li><li>21</li><li>22</li><li>23</li><li>24</li><li>25</li><li>26</li><li>27</li><li>28</li><li>29</li><li>30</li><li>31</li> </ul>
<input type="hidden" value="16" id="wnb_day" name="book[day]">
</div>
<div class="wnb-date wnb-month ddl">
<span>April</span>
<ul style="width: 145px; display: none">
<li>January</li><li>February</li><li>March</li><li>April</li><li>May</li><li>June</li><li>July</li><li>August</li><li>September</li><li>October</li><li>November</li><li>December</li>
</ul>
<input type="hidden" value="July" id="wnb_month" name="book[month]">
</div>
<div class="wnb-date wnb-year ddl">
<span>2015</span>
<ul style="width: 109px; display: none">
<li>2015</li><li>2014</li><li>2013</li><li>2012</li><li>2011</li><li>2010</li><li>2009</li><li>2008</li><li>2007</li><li>2006</li><li>2005</li><li>2004</li><li>2003</li><li>2002</li><li>2001</li><li>2000</li><li>1999</li><li>1998</li><li>1997</li><li>1996</li><li>1995</li><li>1994</li><li>1993</li><li>1992</li><li>1991</li><li>1990</li><li>1989</li><li>1988</li><li>1987</li><li>1986</li><li>1985</li><li>1984</li><li>1983</li><li>1982</li><li>1981</li><li>1980</li><li>1979</li><li>1978</li><li>1977</li><li>1976</li><li>1975</li><li>1974</li><li>1973</li><li>1972</li><li>1971</li><li>1970</li><li>1969</li><li>1968</li><li>1967</li><li>1966</li><li>1965</li><li>1964</li><li>1963</li><li>1962</li><li>1961</li><li>1960</li><li>1959</li><li>1958</li><li>1957</li><li>1956</li><li>1955</li><li>1954</li><li>1953</li><li>1952</li><li>1951</li><li>1950</li><li>1949</li><li>1948</li><li>1947</li><li>1946</li><li>1945</li><li>1944</li><li>1943</li><li>1942</li><li>1941</li><li>1940</li><li>1939</li><li>1938</li><li>1937</li><li>1936</li><li>1935</li><li>1934</li><li>1933</li><li>1932</li><li>1931</li><li>1930</li><li>1929</li><li>1928</li><li>1927</li><li>1926</li><li>1925</li><li>1924</li><li>1923</li><li>1922</li><li>1921</li><li>1920</li> </ul>
<input type="hidden" value="2015" id="wnb_year" name="book[year]">
</div>
</div>
<div style="clear: both"></div>
</div>
-->
<div class="row">
<div class="field">Date of Birth<br><span>DD-MM-YYYY</span></div>
<div class="field2"><input value="" id="wnb_bdate" class="wnb-input" name="bdate" type="text"></div>
<div style="clear: both"></div>
</div>
<div class="row">
<div class="field">Phone Number</div>
<div class="field2"><input value="" id="wnb_phone" class="wnb-input" name="phone" type="text"></div>
<div style="clear: both"></div>
</div>
<div class="row">
<div class="field">E-mail</div>
<div class="field2"><input value="" id="wnb_email" class="wnb-input" name="email" type="text"></div>
<div style="clear: both"></div>
</div>
<div class="row">
<div class="field">Best Time To Call</div>
<div class="field2"><input value="" id="wnb_besttime" class="wnb-input" name="besttime" type="text"></div>
<div style="clear: both"></div>
</div>
<div class="row">
<div class="field">Where did you hear about us?</div>
<div class="field2"><input value="" id="wnb_hearaboutus" class="wnb-input" name="hearaboutus" type="text"></div>
<div style="clear: both"></div>
</div>
<div class="row" style="float: right; margin-right: -4px">
<!-- <div class="book-button" style="margin-top: 12px"><input type="submit" alt="SEND" value="" src="http://www.focusclinics.com
/wp-content/themes/focusclinics/images/bt-send-big.png" class="wnb-send-button" style="cursor: pointer; border: 0; background: transparent; width: 295px; height: 55px"></div> -->
<div class="book-button2" style="margin-top: 12px; margin-right: 8px;"><input value="BOOK NOW" class="wnb-send-button" style="cursor: pointer; border: 0; background:#8b0; color:#fff; padding:10px; font-size:16px;" name="submit" type="submit"></div>
</div>
<div style="clear: both"></div>
</div>
</form>
<div id="book-message" style="display: none;"><table border="0" cellpadding="0" cellspacing="0"><tbody><tr><td>Please enter your details</td></tr></tbody></table></div>
</div>
<!-- InstanceEndEditable -->
<div class="book-a-consultation-button"><a href="booking.php?promo=WEBSITE_B"><img src="/uk/images/book-a-consultation.jpg" width="375" height="40" alt="Book a consultation"></a></div>
</div>
<div class="social-buttons">
<style type="text/css">
.social-buttons {
float: left;
margin: 10px 0px;
}
.social-buttons #tweet {
margin-right: 10px;
float: left;
}
.social-buttons #facebook {
width: 50px;
overflow: hidden;
margin-right: 9px;
float:left;
}
.social-buttons #google-plus {
float: left;
}
.pin-it-btn-wrapper, .pin-it-btn-wrapper-shortcode, .pin-it-btn-wrapper-widget {
float: left;
}
#hidden {display:none;}
</style>
<div id="tweet">
<iframe scrolling="no" frameborder="0" allowtransparency="true" src="http://platform.twitter.com/widgets/tweet_button.1340179658.html#_=1341774358199&count=none&id=twitter-widget-0&lang=en&original_referer=http%3A%2F%2Fwww.focusclinics.com%2Four-treatments%2Fz-lasik%2F&size=m&text=http%3A%2F%2Fwww.focusclinics.com%2Four-treatments%2Fz-lasik%2F&url=http%3A%2F%2Fwww.focusclinics.com%2Four-treatments%2Fz-lasik%2F" class="twitter-share-button twitter-count-none" style="width: 55px; height: 20px;" title="Twitter Tweet Button"></iframe>
<script src="http://platform.twitter.com/widgets.js" type="text/javascript"></script>
</div>
<div id="facebook">
<iframe scrolling="no" frameborder="0" allowtransparency="true" style="border:none; overflow:hidden; width:80px; height:21px;" src="http://www.facebook.com/plugins/like.php?href=http%3A%2F%2Fwww.focusclinics.com%2Four-treatments%2Fz-lasik%2F&layout=button_count&show_faces=true&width=80&action=like&font=lucida+grande&colorscheme=light&height=21"></iframe>
</div>
<div class="pin-it-btn-wrapper-shortcode "><a href="http://pinterest.com/pin/create/button/?url=http%3A%2F%2Fwww.focusclinics.com%2Four-treatments%2Fz-lasik%2F&media=http%3A%2F%2Fwww.focusclinics.com%2Fwp-content%2Fuploads%2F2012%2F05%2FWavelight_Equipment.jpg&description=Z-LASIK" count-layout="none" class="pin-it-button-no-iframe pin-it-button-user-selects-image" rel="nobox"><img border="0" class="pib-count-img" src="//assets.pinterest.com/images/PinExt.png" title="Pin It" /></a></div>
<div id="google-plus" style="margin-left: 12px">
<a href="laser-eye-treatment.php">
<g:plusone size="medium" annotation="inline" width="120" href="http://www.focusclinics.com/our-treatments/z-lasik/"></g:plusone>
</a> <!-- Place this render call where appropriate -->
<script type="text/javascript">
(function() {
var po = document.createElement('script'); po.type = 'text/javascript'; po.async = true;
po.src = 'https://apis.google.com/js/plusone.js';
var s = document.getElementsByTagName('script')[0]; s.parentNode.insertBefore(po, s);
})();
</script></div>
</div>
</div>
</div>
</div>
</div>
<!-- #content -->
</div>
<!-- #primary -->
<p> </p>
<div class="sidebar">
<div class="menu_simple"><h2>Quick Links</h2>
<ul>
<li><a href = "/individual-patient-care.php">Individual patient care</a></li>
<li><a href = "/z-lasik.php">Z lasik</a></li>
<li><a href = "/short-sighted-treatment.php">Short sighted treatment</a></li>
<li><a href = "/astigmatism.php">Astigmatism</a></li>
<li><a href = "/long-sightedness.php">Long sightedness</a></li>
<li><a href = "/aftercare.php">After care</a></li>
<li><a href = "/surgery-day.php">Surgery day</a></li>
<li><a href = "/dry-eyes.php">Dry eyes</a></li>
<li><a href = "/prk-lasek-procedure.php">Prk lasek procedure</a></li>
<li><a href = "/contact-us.php">Contact us</a></li>
<li><a href = "/book-a-consultation.php">Book a consultation</a></li>
<li><a href = "/meet-your-laser-eye-surgeons.php">Meet your laser eye surgeons</a></li>
<li><a href = "/your-safety.php">Your safety</a></li>
<li><a href = "/treatment-and-you.php">Treatment and you</a></li>
<li><a href = "/blepharitis.php">Blepharitis</a></li>
<li><a href = "/short-sight-why-is-vision-blurred.php">Short sight why is vision blurred</a></li>
<li><a href = "/reading-glasses-and-presbyopia.php">Reading glasses and presbyopia</a></li>
<li><a href = "/types-of-laser-eye-surgery.php">Types of laser eye surgery</a></li>
<li><a href = "/your-consultation.php">Your consultation</a></li>
<li><a href = "/short-sight-treatment-options.php">Short sight treatment options</a></li>
</ul>
</div>
<div class="dotted-title" style="margin-top: 3px; padding-bottom: 7px"></div>
<div style="margin-top: 10px;"><img src="/uk/images/getintouch.png" alt="Get in touch" /></div>
<div class="post">Fill in your details and we will call you back or reply to your email or call <strong>020 7307 8250.</strong></div>
<div class="wpcf7" id="wpcf7-f4291-o1" lang="en-US" dir="ltr">
<div class="screen-reader-response"></div>
<?php
if(!empty($form_errors)){
echo "<p class='err'>".nl2br($form_errors)."</p>";
}
?>
<form name="" action="<?php echo htmlentities($_SERVER['PHP_SELF']); ?>" method="post" class="wpcf7-form" novalidate>
<div style="display: none;">
<input type="hidden" name="_wpcf7" value="4291" />
<input type="hidden" name="_wpcf7_version" value="4.0.3" />
<input type="hidden" name="_wpcf7_locale" value="en_US" />
<input type="hidden" name="_wpcf7_unit_tag" value="wpcf7-f4291-o1" />
<input type="hidden" name="_wpnonce" value="d9932b33a5" />
</div>
<p style="font-size: 12px;">Name (required)<br />
<span class="wpcf7-form-control-wrap text-944">
<input type="text" name="text-944" value="" size="28" class="wpcf7-form-control wpcf7-text wpcf7-validates-as-required" aria-required="true" aria-invalid="false" placeholder="" />
</span></p>
<p style="font-size: 12px;">Email (required)<br />
<span class="wpcf7-form-control-wrap your-email">
<input type="email" name="your-email" value="" size="28" class="wpcf7-form-control wpcf7-text wpcf7-email wpcf7-validates-as-required wpcf7-validates-as-email" aria-required="true" aria-invalid="false" placeholder="" />
</span></p>
<p style="font-size: 12px;">Telephone (required)<br />
<span class="wpcf7-form-control-wrap tel-124">
<input type="tel" name="tel-124" value="" size="28" class="wpcf7-form-control wpcf7-text wpcf7-tel wpcf7-validates-as-required wpcf7-validates-as-tel" aria-required="true" aria-invalid="false" placeholder="" />
</span> </p>
<p style="font-size: 12px;">Message<br />
<span class="wpcf7-form-control-wrap your-message">
<textarea name="your-message" cols="40" rows="8" class="wpcf7-form-control wpcf7-textarea" aria-invalid="false" placeholder="Enter your message">Short sighted or long sighted etc</textarea>
</span> </p>
<p>
<input type="submit" value="SUBMIT FORM" class="wpcf7-form-control wpcf7-submit" />
</p>
<div class="wpcf7-response-output wpcf7-display-none"></div>
</form>
</div>
<div class="dotted-title" style="margin-top: 3px; padding-bottom: 7px"></div>
<div class="post">
<h3> <a href="/laser-eye-treatment.php">Our Treatments</a></h3>
Please note the Hurlingham Eye Clinic is a trading style of Focus Clinics.
<p></p>
</div>
</div>
<div style="clear: both"></div>
</div>
<!-- #main --><!-- #page -->
<?php include ($_SERVER["DOCUMENT_ROOT"] . '/includes/footer.php'); ?>
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