<?php include 'header.php'; ?>

<div class="faq_banner">
    <div class="container">
        <div class="row">
            <div class="col-lg-12 col-md-12 col-sm-12 col-xs-12">
                <div class="ban_box text-center clr-white">
                    <h1>Contact Us</h1>
                </div>
            </div>
        </div>
    </div>
</div>


<div class="contact_sec1 sec">
	<div class="container">
		<div class="row">
			<div class="col-lg-7 col-md-7 col-sm-7 col-12">
				<div class="contact_s1_left">
					<h4 class="mb-3">Have a question?</h4>
					<h2 class="mb-5">Send Us A Message</h2>
					<form method="post" action="code.php" onsubmit="return checkform2(this);">
                        <div class="form-group">
                        	<label>Full Name</label>
                            <input type="text" class="form-control" required="required" name="contact_name">
                        </div>
                        <div class="form-group">
                        	<label>Email</label>
                            <input type="email" class="form-control" required="required" name="contact_email">
                        </div>
                        <div class="form-group">
                        	<label>Number</label>
                            <input class="form-control" type="number" required="required" name="contact_num">
                        </div>
                        <div class="form-group">
                        	<label>Email</label>
                            <input type="text" class="form-control" required="required" name="contact_sub">
                        </div>
                        <div class="form-group">
                        	<label>Message</label>
                            <textarea class="form-control" name="contact_msg"></textarea>
                        </div>
                        <div class="form-group">
                            <button type="submit" class="main_btn1" name="contact_btn">Submit</button>
                        </div>
                    </form>
				</div>
			</div>
			<div class="col-lg-4 col-md-4 col-sm-4 col-12 offset-lg-1">
				<div class="contact_s1_right text-center">
					<div class="contact_s1_box mt-5">
						<a href="mailto:info@medbillclaim.com">
						<span><i class="fa-solid fa-envelope"></i></span>
						<h3 class="mt-3 mb-2 clr-blue">Email Us</h3>
						<p class="clr-black">info@medbillclaim.com</p>
						</a>
					</div>
					<div class="contact_s1_box mt-5">
						<a href="tel:+13234483097">
						<span><i class="fa-solid fa-phone-volume"></i></span>
						<h3 class="mt-3 mb-2 clr-blue">Call Us</h3>
						<p class="clr-black">+1 (323) 448-3097</p>
						</a>
					</div>
					<div class="contact_s1_box mt-5">
						<a href="#">
						<span><i class="fa-solid fa-location-dot"></i></span>
						<h3 class="mt-3 mb-2 clr-blue">Locate Us</h3>
						<p class="clr-black">2600 S Loop W, Houston, TX, United States, 77054</p>
						</a>
					</div>
				</div>
			</div>
		</div>
	</div>
</div>


<?php include 'footer.php'; ?>