templates/en/patient-contact.html.twig line 1

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  1. {% extends 'base.html.twig' %}
  3. {% block title %}Contact the CoaguChek Roche Care Centre{% endblock %}
  4. {% block description %}Get in touch with your questions about INR self-testing with a CoaguChek device.{% endblock %}
  6. {% block main %}
  7.     <section class="bg-patient text-white position-relative roche-header">
  8.         <div class="container-fluid">
  9.             <div class="row align-items-center">
  10.                 <div class="col-lg-4 offset-lg-2 py-5 px-0 order-2 order-lg-1">
  11.                     <div class="container">
  12.                         <h1>Get in touch</h1>
  13.                         <p class="mb-0">We are always happy to help.</p>
  14.                     </div>                    
  15.                 </div>
  16.                 <div class="col-lg-6 pe-0 order-1 order-lg-2">
  17.                     <img src="{{ asset('build/images/patient/08-Contact/000-Heroimage_1x.png') }}" srcset="{{ asset('build/images/patient/08-Contact/000-Heroimage_1x.png') }} 1x, {{ asset('build/images/patient/08-Contact/000-Heroimage_2x.png') }} 2x" alt="A woman on the phone reading her drugs instructions" class="w-100" />
  18.                 </div>
  19.             </div>
  20.         </div>
  21.     </section>
  23.     <section class="roche-section__medium">
  24.         <div class="container">
  25.             <div class="row">
  26.                 <div class="col-12 col-lg-7">
  27.                     <h2 class="text-patient">Contact information</h2>
  28.                     <p>The CoaguChek<sup>®</sup> Roche Care Centre is here to answer your questions.</p>
  29.                     <p>Call us toll-free at <a href="tel:+1 (877) 426-2482" class="text-patient fw-bold text-nowrap">+1 (877) 426-2482</a> <br>Monday - Friday between 8am and 5pm (EST).</p>
  30.                     <div class="roche-image roche-image__left">
  31.                         <img class="img-fluid" src="{{ asset('build/images/patient/08-Contact/01-ContactUs_1x.png') }}" srcset="{{ asset('build/images/patient/08-Contact/01-ContactUs_1x.png') }} 1x, {{ asset('build/images/patient/08-Contact/01-ContactUs_2x.png') }} 2x" alt="A grandfather and his granddaughter looking at a tablet">
  32.                     </div>
  33.                 </div>
  34.                 <div class="col-12 col-lg-5 pt-5 pt-lg-0">
  35.                     <h2 class="text-patient">Send a message</h2>
  37.                     {{ form_start(form) }}
  39.                         <p><small>Fields marked with * must be completed.</small></p>
  41.                         {{ form_row(form.subject) }}
  42.                         
  43.                         <div class="row">
  44.                             <div class="col-md-6">{{ form_row(form.firstname) }}</div>
  45.                             <div class="col-md-6">{{ form_row(form.lastname) }}</div>
  46.                         </div>
  48.                         <div class="row">
  49.                             <div class="col-md-6">{{ form_row(form.email) }}</div>
  50.                             <div class="col-md-6">{{ form_row(form.phone) }}</div>
  51.                         </div>    
  53.                         {{ form_row(form.message) }}
  55.                         <p>Roche Diagnostics would like to provide you with relevant news and information on our products and promotions. We would also like to ask you about your experiences and opinion.</p>                    
  56.                         {{ form_rest(form) }}
  58.                         <button class="btn btn-patient text-white">{{ button_label|default('Submit') }}</button>
  59.                     {{ form_end(form) }}
  61.                 </div>
  62.             </div>
  63.         </div>
  65.     </section>
  68.     </div>
  69. {% endblock %}