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58 59 <!-- Facebbook End --> 60<div class="donate"> 61 <div class="container"> 62 <div class="donate-box"> 63 <h3>Contact<span class="black">Us</span></h3> 64 <p>Batra Hospital and Medical Research Centre,<br> 1 Tughlakabad Institutional Area, M.B Road, <br> Near khanpur, New Delhi 110062<br> 65 66 67</p> 68 </div> 69 <div class="donate-box"> 70 71 72 </div> 73 <div class="donate-box"> 74 <a href="callback.php" title="Request Callback" rel="gb_page_center[550, 440]"> 75 <img src="img/call.png" alt="Cancer Treatment" /></a> 76 </div> 77 <div class="donate-updown"> 78 <h6>CONTACT <span class="black">US</span></h6> 79 </div> 80 </div> 81</div><!-- Top Donation Bar --> 82<div class="theme-layout"> 83<header> 84 <div class="container"> 85 <div class="logo"> 86 <a href="index.html" title=""><img src="img/logo.png" alt="" /></a> 87 </div><!-- Logo --> 88 89 <div id="menu"> 90 <ul> 91 <li><a href="index.html" title="">HOME</a> 92 <ul class="drop-down"> 93 <li><a href="about.html" title="">About Us</a></li> 94 <li><a href="services.html" title="">Services & Meeting</a></li> 95 </ul> 96 </li> 97 <li><a href="doctors.html" title="">Doctors</a></li> 98 <li><a href="#" title="">Cancer</a> 99 <ul class="drop-down"> 100 <li><a href="brest.html" title="">Brest Cancer</a></li> 101 <li><a href="cervix.html" title="">Cervix Cancer</a></li> 102 <li><a href="endo.html" title="">Endometrial Cancer</a></li> 103 <li><a href="head_neck.html" title="">Head Neck Cancer</a></li> 104 <li><a href="brain.html" title="">Brain Tumors</a></li> 105 <li><a href="pros.html" title="">Prostate Cancer</a></li> 106 <!-- Gallery With Right Sidebar --> 107 </ul><!-- Drop Down Menu --> 108 </li> 109 <li><a href="treatment.html" title="">Treatment</a> 110 <ul class="drop-down"> 111 <li class="double-drop"><a href="#" title="">Case Study</a> 112 <ul class="second drop-down"> 113 <li><a href="case1.html" title="">Lung Case</a></li> 114 <li><a href="case2.html" title="">HNSCC Case</a></li> 115 </ul> <!-- Double Drop Down Menu --> 116 </li> 117 <li><a href="patience.html" title="">Patient Gallery</a></li> 118 </ul><!-- Drop Down Menu --> 119 </li> 120 <li><a href="http://www.radiotherapyindia.blogspot.in" target="_blank"title="">Blogs</a></li> 121 <li><a href="app.php" title="">Appointment</a></li> 122 <li><a href="contact.html" title="">Contact US</a></li> 123 </ul> 124 </div><!-- Menu --> 125 <select class="ipadMenu"> 126 <option value="index.html">Home</option> 127 <option value="about.html">About Us</option> 128 <option value="services.html">Services & Meeting</option> 129 <option value="doctors.html">Doctor</option> 130 <option value="brest.html">Brest Cancer</option> 131 <option value="cervix.html">Cervix Cancer</option> 132 <option value="endo.html">Endometrial Cancer</option> 133 <option value="head_neck.html">Head Neck Cancer</option> 134 <option value="brain.html">Brain Tumors</option> 135 <option value="pros.html">Prostate Cancer</option> 136 <option value="case1.html" title="">Lung Case</option> 137 <option value="case2.html" title="">HNSCC Case</option> 138 <option value="patience.html" title="">Patient Gallery</option> 139 <option value="http://www.radiotherapyindia.blogspot.in" target="_blank"title="">Blogs</option> 140 <option value="app.php" title="">Appointment</option> 141 <option value="contact.html" title="">Contact US</option> 142 143 </select><!-- Select Navigation On Responsive Version --> 144 </div> 145</header><!-- Header --> 146 147<section> 148 <div class="full-page-head"> 149 <div class="full-page-title"> 150 <h1>Appointment</h1> 151 152 </div> 153 </div> 154 <div class="intro"> 155 <div class="container"> 156 <div class="service-box span11"> 157 <div class="intro-box-title"> 158 <h2 align="center">Book Your Appointment</h2> 159 </div> 160 <p align="center"> 161 162 163<div class="ddfmwrap"><form class="ddfm" method="post" action="http://radiotherapy.in/app.php" enctype="multipart/form-data"> 164 165<fieldset><legend>Kindly provide following complete details</legend> 166 167<p class="fieldwrap"><label for="fm_name"><span class="required">*</span> Full Name</label>
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