/home/hdwebsolution/public_html/try/sareensurgicals/app/Views/front/lifestyle.php
<div class="ttm-page-title-row text-center">
<div class="section-overlay"></div>
<div class="title-box text-center">
<div class="container">
<div class="page-title-heading">
<h1 class="title">Life style</h1>
</div>
<div class="breadcrumb-wrapper">
<div class="container">
<span><a title="Homepage" href="<?=base_url();?>"><i class="fa fa-home"></i> Home</a></span>
<span class="ttm-bread-sep ttm-textcolor-white"> ⁄ </span>
<span class="ttm-textcolor-white">Life style</span>
</div>
</div>
</div>
</div>
</div>
<div class="site-main">
<!-- checkout-section -->
<section class="ttm-row checkout-section ttm-bgcolor-grey break-991-colum clearfix">
<div class="container">
<!-- row -->
<div class="row">
<div class="col-lg-12">
<div class="coupon_toggle">
<div class="coupon_code">
Life style
</div>
</div>
<h3>Life style</h3>
<form name="checkout" method="post" class="checkout row box-shadow1" action="<?=base_url('lifestyle');?>">
<div class="row">
<div class="col-sm-6">
<p class="checkout-form">
<label>DIET <abbr class="required" title="required">*</abbr></label>
<input required type="text" class="input-text" name="ldiet" placeholder="DIET" value="">
</p>
</div>
<div class="col-sm-6">
<p class="checkout-form">
<label>DRINK <abbr class="required" title="required">*</abbr></label>
<select required name="ldrink" class="country_to_state country_select" tabindex="-1" aria-hidden="true">
<option value="">Choose one…</option>
<option value="Yes">Yes</option>
<option value="NO">NO</option>
<option value="Doesn't Matter">Doesn't Matter</option>
</select>
</p>
</div>
<div class="col-sm-6">
<p class="checkout-form">
<label>SMOKE <abbr class="required" title="required">*</abbr></label>
<select required name="lsmoke" class="country_to_state country_select" tabindex="-1" aria-hidden="true">
<option value="">Choose one…</option>
<option value="Yes">Yes</option>
<option value="NO">NO</option>
<option value="Doesn't Matter">Doesn't Matter</option>
</select>
</p>
</div>
<div class="col-sm-6">
<p class="checkout-form">
<label>LIVING WITH <abbr class="required" title="required">*</abbr></label>
<input required type="text" class="input-text" name="lliving" placeholder="LIVING WITH" value="">
</p>
</div>
</div>
<button class="ttm-btn ttm-btn-size-md ttm-btn-shape-round ttm-btn-style-fill ttm-btn-color-black mt-50" type="submit">Next</button>
</form>
<div class="col-md-12 text-center">
</div>
</div>
</div>
</section></div>