<!DOCTYPE html>
<html lang="ru">
<head>
    <meta charset="UTF-8">
    <meta name="viewport" content="width=device-width, initial-scale=1.0">
    <title>Запись на процедуру</title>
    <style>
        body {
            font-family: Arial, sans-serif;
            background-color: #f7f7f7;
            margin: 0;
            padding: 20px;
        }

        .lp-form-3 {
            background-color: white;
            border-radius: 8px;
            box-shadow: 0 4px 8px rgba(0, 0, 0, 0.1);
            padding: 20px;
            max-width: 400px;
            margin: auto;
        }

        .lp-header-title-3 {
            font-size: 24px;
            margin-bottom: 10px;
        }

        .lp-header-text-2 {
            font-size: 14px;
            margin-bottom: 20px;
        }

        .lp-label-text {
            margin-bottom: 5px;
            font-weight: bold;
        }

        input[type="text"],
        input[type="tel"] {
            width: 100%;
            padding: 10px;
            margin-bottom: 15px;
            border: 1px solid #ccc;
            border-radius: 4px;
        }

        button {
            background-color: #28a745;
            color: white;
            padding: 10px;
            border: none;
            border-radius: 4px;
            cursor: pointer;
            width: 100%;
        }

        button:hover {
            background-color: #218838;
        }

        .lp-form-3__close {
            cursor: pointer;
            float: right;
            margin-top: -10px;
        }
    </style>
</head>
<body>

<div class="lp-form-3 _lp-popup" id="_lp_block_71252705" data-block-layout="1551061" data-elem-type="block">
    <div class="lp-form-3__inner" data-elem-type="card_container" data-lp-selector=".lp-form-3__inner">
        <span class="lp-form-3__close js-close-popup" data-elem-type="card_container" data-lp-selector="._close-line">
            <span class="_close-line"></span>
            <span class="_close-line"></span>
        </span>
        <div class="lp-form-3__title-wrapper">
            <div class="lp-header-title-3 lp-form-3__title" data-path="title">
                <span>Запись на процедуру</span>
            </div>
            <div class="lp-header-text-2 lp-form-3__subtitle" data-elem-type="text" data-path="text">
                <span>Заполните, пожалуйста, данные. Я Вам перезвоню и уточним все детали</span><br>
            </div>
        </div>
        <div class="lp-form-tpl">
            <form method="post" action="send_to_telegram.php">
                <input type="hidden" name="params[hide_title]" value="1" />
                <div class="lp-form-tpl__item _type-text _required">
                    <div class="lp-label-text lp-form-tpl__item-label">
                        <span class="lp-alert-text">* </span>Имя
                    </div>
                    <div class="lp-form-tpl__item-field">
                        <input type="text" name="name" required />
                    </div>
                </div>
                <div class="lp-form-tpl__item _type-phone _required">
                    <div class="lp-label-text lp-form-tpl__item-label">
                        <span class="lp-alert-text">* </span>Телефон
                    </div>
                    <div class="lp-form-tpl__item-field">
                        <input type="tel" name="phone" required />
                    </div>
                </div>
                <div class="lp-form-tpl__button-wrapper">
                    <button type="submit">Записаться</button>
                </div>
            </form>
        </div>
    </div>
</div>

</body>
</html>