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<!DOCTYPE html>
<html lang="en">
<head>
<meta charset="utf-8">
<title>OakBend Med Center</title>
<meta name="viewport" content="width=device-width, initial-scale=1.0, user-scalable=0">
<!-- Favicons -->
<link href="assets/img/favicon.png" rel="icon">
<!-- Bootstrap CSS -->
<link rel="stylesheet" href="assets/css/bootstrap.min.css">
<!-- Fontawesome CSS -->
<link rel="stylesheet" href="assets/plugins/fontawesome/css/fontawesome.min.css">
<link rel="stylesheet" href="assets/plugins/fontawesome/css/all.min.css">
<!-- Feathericon CSS -->
<link rel="stylesheet" href="assets/css/feather.css">
<!-- Select2 CSS -->
<link rel="stylesheet" href="assets/plugins/select2/css/select2.min.css">
<!-- Bootstrap CSS -->
<link rel="stylesheet" href="assets/plugins/bootstrap-tagsinput/css/bootstrap-tagsinput.css">
<link rel="stylesheet" href="assets/plugins/dropzone/dropzone.min.css">
<!-- Main CSS -->
<link rel="stylesheet" href="assets/css/style.css">
</head>
<body>
<!-- Main Wrapper -->
<div class="main-wrapper">
<!-- Header -->
<header class="header">
<nav class="navbar navbar-expand-lg header-nav">
<div class="navbar-header">
<a id="mobile_btn" href="javascript:void(0);">
<span class="bar-icon bar-icon-one">
<span></span>
<span></span>
<span></span>
</span>
</a>
<a href="index.php" class="navbar-brand logo">
<img src="assets/img/logo.png" class="img-fluid" alt="Logo">
</a>
</div>
<div class="main-menu-wrapper">
<div class="menu-header">
<a href="index.php" class="menu-logo">
<img src="assets/img/logo.png" class="img-fluid" alt="Logo">
</a>
<a id="menu_close" class="menu-close" href="javascript:void(0);">
<i class="fas fa-times"></i>
</a>
</div>
<ul class="main-nav">
<li class="has-submenu active">
<a href="index.php">Home </a>
</li>
<li class="has-submenu">
<a href="">Find A Doctor <i class="fas fa-chevron-down"></i></a>
<ul class="submenu">
<li><a href="doctor-dashboard.html">Doctor Dashboard</a></li>
<li><a href="appointments.html">Appointments</a></li>
<li><a href="schedule-timings.html">Schedule Timing</a></li>
<li><a href="my-patients.html">Patients List</a></li>
<li><a href="patient-profile.html">Patients Profile</a></li>
<li><a href="chat-doctor.html">Chat</a></li>
<li><a href="invoices.html">Invoices</a></li>
<li><a href="doctor-profile-settings.html">Profile Settings</a></li>
<li><a href="reviews.html">Reviews</a></li>
<li><a href="doctor-register.html">Doctor Register</a></li>
<li class="has-submenu">
<a href="doctor-blog.html">Blog</a>
<ul class="submenu">
<li><a href="doctor-blog.html">Blog</a></li>
<li><a href="blog-details.html">Blog view</a></li>
<li><a href="doctor-add-blog.html">Add Blog</a></li>
</ul>
</li>
</ul>
</li>
<li class="has-submenu">
<a href="">COVID-19 <i class="fas fa-chevron-down"></i></a>
<ul class="submenu">
<li class="has-submenu">
<a href="#">Doctors</a>
<ul class="submenu">
<li><a href="map-grid.html">Map Grid</a></li>
<li><a href="map-list.html">Map List</a></li>
</ul>
</li>
<li><a href="search.html">Search Doctor</a></li>
<li><a href="doctor-profile.html">Doctor Profile</a></li>
<li><a href="booking.html">Booking</a></li>
<li><a href="checkout.html">Checkout</a></li>
<li><a href="booking-success.html">Booking Success</a></li>
<li><a href="patient-dashboard.html">Patient Dashboard</a></li>
<li><a href="favourites.html">Favourites</a></li>
<li><a href="chat.html">Chat</a></li>
<li><a href="profile-settings.html">Profile Settings</a></li>
<li><a href="change-password.html">Change Password</a></li>
</ul>
</li>
<li class="has-submenu">
<a href="">About Us <i class="fas fa-chevron-down"></i></a>
<ul class="submenu">
<li><a href="pharmacy-index.html">Pharmacy</a></li>
<li><a href="pharmacy-details.html">Pharmacy Details</a></li>
<li><a href="pharmacy-search.html">Pharmacy Search</a></li>
<li><a href="product-all.html">Product</a></li>
<li><a href="product-description.html">Product Description</a></li>
<li><a href="cart.html">Cart</a></li>
<li><a href="product-checkout.html">Product Checkout</a></li>
<li><a href="payment-success.html">Payment Success</a></li>
<li><a href="pharmacy-register.html">Pharmacy Register</a></li>
</ul>
</li>
<li class="has-submenu">
<a href="">Services <i class="fas fa-chevron-down"></i></a>
<ul class="submenu">
<li><a href="voice-call.html">Voice Call</a></li>
<li><a href="video-call.html">Video Call</a></li>
<li><a href="search.html">Search Doctors</a></li>
<li><a href="calendar.html">Calendar</a></li>
<li><a href="components.html">Components</a></li>
<li class="has-submenu">
<a href="invoices.html">Invoices</a>
<ul class="submenu">
<li><a href="invoices.html">Invoices</a></li>
<li><a href="invoice-view.html">Invoice View</a></li>
</ul>
</li>
<li><a href="blank-page.html">Starter Page</a></li>
<li><a href="about-us.html">About Us</a></li>
<li><a href="contact-us.html">Contact Us</a></li></li>
<li><a href="login.html">Login</a></li>
<li><a href="register.html">Register</a></li>
<li><a href="forgot-password.html">Forgot Password</a></li>
</ul>
</li>
<li class="has-submenu">
<a href="">Location <i class="fas fa-chevron-down"></i></a>
<ul class="submenu">
<li><a href="blog-list.html">Blog List</a></li>
<li><a href="blog-grid.html">Blog Grid</a></li>
<li><a href="blog-details.html">Blog Details</a></li>
</ul>
</li>
<li class="has-submenu">
<a href="#" target="_blank">Admin <i class="fas fa-chevron-down"></i></a>
<ul class="submenu">
<li><a href="admin/index.html" target="_blank">Admin</a></li>
<li><a href="pharmacy/index.html" target="_blank">Pharmacy Admin</a></li>
</ul>
</li>
<li class="login-link">
<a href="login.html">Login / Signup</a>
</li>
</ul>
</div>
<ul class="nav header-navbar-rht">
<li class="nav-item contact-item">
<div class="header-contact-img">
<i class="far fa-hospital"></i>
</div>
<div class="header-contact-detail">
<p class="contact-header">Contact</p>
<p class="contact-info-header"> 281-341-3000</p>
</div>
</li>
</ul>
</nav>
</header>
<!-- /Header -->
<!-- /Header -->
<!-- Breadcrumb -->
<div class="breadcrumb-bar">
<div class="container-fluid">
<div class="row align-items-center">
<div class="col-md-12 col-12">
<nav aria-label="breadcrumb" class="page-breadcrumb">
<ol class="breadcrumb">
<li class="breadcrumb-item"><a href="index.html">Home</a></li>
<li class="breadcrumb-item active" aria-current="page">Booking Form</li>
</ol>
</nav>
<h2 class="breadcrumb-title">Booking Form</h2>
</div>
</div>
</div>
</div>
<!-- /Breadcrumb -->
<!-- Page Content -->
<div class="content">
<div class="container-fluid">
<div class="row">
<div class="col-md-12 col-lg-12 col-xl-12">
<!-- Basic Information -->
<div class="card" style="background-color: #f5f5f5;">
<div class="card-body">
<h4 class="card-title">Personal Information</h4>
<div class="row form-row">
<div class="col-md-3">
<div class="form-group">
<label>Patient's First Name <span class="text-danger">*</span></label>
<input type="text" class="form-control">
</div>
</div>
<div class="col-md-3">
<div class="form-group">
<label>Patient's Middle Name <span class="text-danger">*</span></label>
<input type="text" class="form-control">
</div>
</div>
<div class="col-md-3">
<div class="form-group">
<label>Patient's Last Name <span class="text-danger">*</span></label>
<input type="text" class="form-control">
</div>
</div>
<div class="col-md-3">
<div class="form-group">
<label>Patient's Address <span class="text-danger">*</span></label>
<input type="text" class="form-control">
</div>
</div>
<div class="col-md-3">
<div class="form-group">
<label>Address Line 2 </label>
<input type="text" class="form-control">
</div>
</div>
<div class="col-md-3">
<div class="form-group">
<label>City <span class="text-danger">*</span></label>
<input type="text" class="form-control">
</div>
</div>
<div class="col-md-3">
<div class="form-group">
<label>State <span class="text-danger">*</span></label>
<select class="select form-control">
<option>Select State</option>
<option value="AL">AL</option>
<option value="AK">AK</option>
<option value="AR">AR</option>
<option value="AZ">AZ</option>
<option value="CA">CA</option>
<option value="CO">CO</option>
<option value="CT">CT</option>
<option value="DC">DC</option>
<option value="DE">DE</option>
<option value="FL">FL</option>
<option value="GA">GA</option>
<option value="HI">HI</option>
<option value="IA">IA</option>
<option value="ID">ID</option>
<option value="IL">IL</option>
<option value="IN">IN</option>
<option value="KS">KS</option>
<option value="KY">KY</option>
<option value="LA">LA</option>
<option value="MA">MA</option>
<option value="MD">MD</option>
<option value="ME">ME</option>
<option value="MI">MI</option>
<option value="MN">MN</option>
<option value="MO">MO</option>
<option value="MS">MS</option>
<option value="MT">MT</option>
<option value="NC">NC</option>
<option value="NE">NE</option>
<option value="NH">NH</option>
<option value="NJ">NJ</option>
<option value="NM">NM</option>
<option value="NV">NV</option>
<option value="NY">NY</option>
<option value="ND">ND</option>
<option value="OH">OH</option>
<option value="OK">OK</option>
<option value="OR">OR</option>
<option value="PA">PA</option>
<option value="RI">RI</option>
<option value="SC">SC</option>
<option value="SD">SD</option>
<option value="TN">TN</option>
<option value="TX">TX</option>
<option value="UT">UT</option>
<option value="VT">VT</option>
<option value="VA">VA</option>
<option value="WA">WA</option>
<option value="WI">WI</option>
<option value="WV">WV</option>
<option value="WY">WY</option>
</select>
</div>
</div>
<div class="col-md-3">
<div class="form-group">
<label>Postal Code <span class="text-danger">*</span></label>
<input type="text" class="form-control">
</div>
</div>
<div class="col-md-3">
<div class="form-group">
<label>Patient's Sex<span class="text-danger">*</span></label>
<select class="select form-control">
<option>Select</option>
<option>Male</option>
<option>Female</option>
<option>Others</option>
</select>
</div>
</div>
<div class="col-md-3">
<div class="form-group">
<label>Patient's Birth Date<span class="text-danger">*</span></label>
<input type="text" class="form-control">
</div>
</div>
<div class="col-md-3">
<div class="form-group">
<label>Phone Number<span class="text-danger">*</span></label>
<input type="text" class="form-control">
</div>
</div>
<div class="col-md-3">
<div class="form-group">
<label>Email Address</label>
<input type="text" class="form-control">
</div>
</div>
</div></div></div>
<div class="card" style="background-color: #033f63;
color: #ffff;">
<div class="card-body">
<h4 class="card-title" style="color: #ffff !important;">Insurance Information</h4>
<div class="row form-row">
<div class="col-md-3">
<div class="form-group">
<label>Who is your insurance carrier?</label>
<select class="select form-control">
<option>Select</option>
<option>Aetna</option>
<option>Aetna Medicaid/CHIP</option>
<option>Aetna Medicare</option>
<option>Amerigroup</option>
<option>Amerigroup Star/Star Plus</option>
<option>Blue Cross Blue Shield Medicare</option>
<option>Cigna</option>
<option>Cigna Medicare</option>
<option>Community Health Choice</option>
<option>Humana</option>
<option>Medicare</option>
<option>United Healthcare</option>
</select>
</div>
</div>
<div class="col-md-3">
<div class="form-group">
<label>What is your insurance plan?</label>
<input type="text" class="form-control">
</div>
</div>
<div class="col-md-3">
<div class="form-group">
<label>Insurance Group Number</label>
<input type="text" class="form-control">
</div>
</div>
<div class="col-md-3">
<div class="form-group">
<label>Insurance Policy Number</label>
<input type="text" class="form-control">
</div>
</div>
<h4 class="card-title" style="color: #ffff !important;">Subscriber</h4>
<div class="col-md-3">
<div class="form-group">
<label>First</label>
<input type="text" class="form-control">
</div>
</div>
<div class="col-md-3">
<div class="form-group">
<label>Middle</label>
<input type="text" class="form-control">
</div>
</div>
<div class="col-md-3">
<div class="form-group">
<label>Last</label>
<input type="text" class="form-control">
</div>
</div>
<div class="col-md-3">
<div class="form-group">
<label>Date of Birth</label>
<input type="text" class="form-control">
</div>
</div>
</div></div></div>
<div class="card" style="background-color: #f5f5f5;">
<div class="card-body">
<h4 class="card-title">General Information</h4>
<div class="row form-row">
<div class="col-md-3">
<div class="form-group">
<label>Reason for Visit</label>
<select class="select form-control">
<option>Select Procedure</option>
<optgroup label="Imaging">
<option>MRI 1.5T Wide Bore with Contrast</option>
<option>MRI 1.5T Wide Bore without Contrast</option>
<option>MRI 3T Wide Bore with Contrast</option>
<option>MRI 3T Wide Bore without Contrast</option>
<option>MRI 3T with Contrast</option>
<option>MRI 3T without Contrast</option>
<option>MRI with Contrast</option>
<option>MRI without Contrast</option>
<option>CT Scan with Contrast</option>
<option>CT Scan without Contrast</option>
<option>Breast Ultrasound</option>
<option>Dexa Scan (Bone Density)</option>
<option>Echocardiogram</option>
<option>Fluoroscopy</option>
<option>Heart Scans/Vascular Screenings</option>
<option>Mammogram - 3D Screening</option>
<option>Mammogram - Diagnostic</option>
<option>Ultrasound</option>
<option>Vascular Ultrasound</option>
</optgroup>
<optgroup label="Cellular and Chemical Analysis">
<option>blood count</option>
<option>blood typing</option>
<option>bone marrow aspiration</option>
<option>cephalin-cholesterol flocculation</option>
<option>enzyme analysis</option>
<option>epinephrine tolerance test</option>
<option>glucose tolerance test</option>
<option>hematocrit</option>
<option>immunologic blood test</option>
<option>inulin clearance</option>
<option>serological test</option>
<option>thymol turbidity</option>
</optgroup>
<optgroup label="Physical & Visual Examination">
<option>auscultation</option>
<option>biopsy</option>
<option>bronchoscopy</option>
<option>ardiac catheterization</option>
<option>colposcopy</option>
<option>Dick test</option>
<option>endoscopy</option>
<option>esophagogastroduodenoscopy</option>
<option>gynecological examination</option>
<option>laparoscopy</option>
<option>mediastinoscopy</option>
<option>nasopharyngolaryngoscopy</option>
<option>palpation</option>
<option>percussion</option>
<option>Rubin's test</option>
<option>semen analysis</option>
<option>skin test</option>
</optgroup>
</select>
</div>
</div>
<div class="col-md-3">
<div class="form-group">
<label>Guarantor's Relationship to Patient<span class="text-danger">*</span></label>
<select class="select form-control">
<option>Select</option>
<option>Self</option>
<option>Spouse</option>
<option>Parent/Guardian</option>
<option>Other</option>
</select>
</div>
</div>
<div class="col-md-3">
<div class="form-group">
<label>Are you a new or existing patient to Oakbend Medical Center?<span class="text-danger">*</span></label>
<select class="select form-control">
<option>Select</option>
<option>New</option>
<option>Existing</option>
</select>
</div>
</div>
<div class="col-md-3">
<div class="form-group">
<label>Have you ever had a reaction to contrast given during a previous procedure?<span class="text-danger">*</span></label>
</div>
<div class="form-check">
<input class="form-check-input" type="radio" name="flexRadioDefault" id="flexRadioDefault1">
<label class="form-check-label" for="flexRadioDefault1">Yes </label></div>
<div class="form-check">
<input class="form-check-input" type="radio" name="flexRadioDefault" id="flexRadioDefault1">
<label class="form-check-label" for="flexRadioDefault1">No </label></div>
</div>
<div class="col-md-3">
<div class="form-group">
<label>I would like to stay connected with Oakbend Hospital System on upcoming events, health tips, and newsletters</label>
</div>
<div class="form-check">
<input class="form-check-input" type="radio" name="flexRadioDefault" id="flexRadioDefault1">
<label class="form-check-label" for="flexRadioDefault1">Yes </label></div>
<div class="form-check">
<input class="form-check-input" type="radio" name="flexRadioDefault" id="flexRadioDefault1">
<label class="form-check-label" for="flexRadioDefault1">No </label></div>
</div>
<div class="col-md-3">
<div class="form-group">
<label>Do you weigh more than 350 pounds?<span class="text-danger">*</span></label>
</div>
<div class="form-check">
<input class="form-check-input" type="radio" name="flexRadioDefault" id="flexRadioDefault1">
<label class="form-check-label" for="flexRadioDefault1">Yes </label></div>
<div class="form-check">
<input class="form-check-input" type="radio" name="flexRadioDefault" id="flexRadioDefault1">
<label class="form-check-label" for="flexRadioDefault1">No </label></div>
</div>
<div class="col-md-3">
<div class="form-group">
<label>Are you diabetic?<span class="text-danger">*</span></label>
</div>
<div class="form-check">
<input class="form-check-input" type="radio" name="flexRadioDefault" id="flexRadioDefault1">
<label class="form-check-label" for="flexRadioDefault1">Yes </label></div>
<div class="form-check">
<input class="form-check-input" type="radio" name="flexRadioDefault" id="flexRadioDefault1">
<label class="form-check-label" for="flexRadioDefault1">No </label></div>
</div>
<div class="col-md-3">
<div class="form-group">
<label>Please list additional tests needed </label>
<input type="text" class="form-control">
</div>
</div>
<div class="col-md-3">
<div class="form-group">
<label>Are you pregnant or is there a possibility that you are pregnant?<span class="text-danger">*</span></label>
</div>
<div class="form-check">
<input class="form-check-input" type="radio" name="flexRadioDefault" id="flexRadioDefault1">
<label class="form-check-label" for="flexRadioDefault1">Yes </label></div>
<div class="form-check">
<input class="form-check-input" type="radio" name="flexRadioDefault" id="flexRadioDefault1">
<label class="form-check-label" for="flexRadioDefault1">No </label></div>
</div>
<div class="col-md-3">
<div class="form-group">
<label>Are you on dialysis?<span class="text-danger">*</span></label>
</div>
<div class="form-check">
<input class="form-check-input" type="radio" name="flexRadioDefault" id="flexRadioDefault1">
<label class="form-check-label" for="flexRadioDefault1">Yes </label></div>
<div class="form-check">
<input class="form-check-input" type="radio" name="flexRadioDefault" id="flexRadioDefault1">
<label class="form-check-label" for="flexRadioDefault1">No </label></div>
</div>
<div class="col-md-3">
<div class="form-group">
<label>Will you require an interpreter for your visit?<span class="text-danger">*</span></label>
</div>
<div class="form-check">
<input class="form-check-input" type="radio" name="flexRadioDefault" id="flexRadioDefault1">
<label class="form-check-label" for="flexRadioDefault1">Yes </label></div>
<div class="form-check">
<input class="form-check-input" type="radio" name="flexRadioDefault" id="flexRadioDefault1">
<label class="form-check-label" for="flexRadioDefault1">No </label></div>
</div>
<div class="col-md-3">
<div class="form-group">
<label>Do you have any special needs, i.e. difficulty standing, difficulty sitting, difficulty laying down, etc? </label>
</div>
<div class="form-check">
<input class="form-check-input" type="radio" name="flexRadioDefault" id="flexRadioDefault1">
<label class="form-check-label" for="flexRadioDefault1">Yes </label></div>
<div class="form-check">
<input class="form-check-input" type="radio" name="flexRadioDefault" id="flexRadioDefault1">
<label class="form-check-label" for="flexRadioDefault1">No </label></div>
</div>
<div class="col-md-3">
<div class="form-group">
<label>Referring/Ordering Physician <span class="text-danger">*</span> </label>
<input type="text" class="form-control">
</div>
</div>
<div class="col-md-3">
<div class="form-group">
<label> How will you provide us with this document for this appointment? <span class="text-danger">*</span> </label>
<select class="select form-control">
<option>Select</option>
<option>I will upload my order/referral at the bottom of this form</option>
<option>I will fax my order/referral </option>
<option>I will email my order/referral </option>
</select>
</div>
</div>
<div class="col-md-3">
<div class="form-group">
<label>Notes (Additional notes if any) </label>
<textarea class="form-control" rows="6"></textarea>
</div>
</div>
<div class="col-md-3">
<div class="form-group">
<label>Attach any required file </label>
<form action="#" class="dropzone"></form>
</div>
<!--div class="upload-wrap">
<div class="upload-images">
<img src="assets/img/features/feature-01.jpg" alt="Upload Image">
<a href="javascript:void(0);" class="btn btn-icon btn-danger btn-sm"><i class="far fa-trash-alt"></i></a>
</div>
<div class="upload-images">
<img src="assets/img/features/feature-02.jpg" alt="Upload Image">
<a href="javascript:void(0);" class="btn btn-icon btn-danger btn-sm"><i class="far fa-trash-alt"></i></a>
</div>
</div-->
</div>
<div class="col-md-6">
<div class="submit-section submit-btn-bottom">
<a href="booking-success.html"> <button type="submit" class="btn btn-primary submit-btn" style="width:100%;">Book Appointment</button>
</a></div>
</div>
<div class="col-md-6">
<div class="submit-section submit-btn-bottom">
<button type="submit" class="btn btn-warning submit-btn" style="width:100%;">Change Appointment</button>
</div>
</div>
</div>
</div>
</div>
<!-- /Basic Information -->
</div>
</div>
</div>
</div>
<!-- /Page Content -->
<!-- Footer -->
<footer class="footer">
<!-- Footer Top -->
<div class="footer-top aos" data-aos="fade-up">
<div class="container-fluid">
<div class="row">
<div class="col-lg-3 col-md-6">
<!-- Footer Widget -->
<div class="footer-widget footer-about">
<div class="footer-logo">
<img src="assets/img/oakbendlogo.png" alt="logo" style="height:45px;">
</div>
<div class="footer-about-content">
<p>We have up-ended the traditional nursing model, putting the patient in the driver’s seat when it comes to his or her plan of care. </p>
<div class="social-icon">
<ul>
<li>
<a href="#" target="_blank"><i class="fab fa-facebook-f"></i> </a>
</li>
<li>
<a href="#" target="_blank"><i class="fab fa-twitter"></i> </a>
</li>
<li>
<a href="#" target="_blank"><i class="fab fa-linkedin-in"></i></a>
</li>
<li>
<a href="#" target="_blank"><i class="fab fa-instagram"></i></a>
</li>
<li>
<a href="#" target="_blank"><i class="fab fa-dribbble"></i> </a>
</li>
</ul>
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</div>
</div>
<!-- /Footer Widget -->
</div>
<div class="col-lg-3 col-md-6">
<!-- Footer Widget -->
<div class="footer-widget footer-menu">
<h2 class="footer-title">Quick Links</h2>
<ul>
<li><a href="#">Careers</a></li>
<li><a href="#">Physician/Staff Login</a></li>
<li><a href="#">Patient Portal</a></li>
<li><a href="#">Pay My Bill</a></li>
<li><a href="#">Contact Us</a></li>
</ul>
</div>
<!-- /Footer Widget -->
</div>
<div class="col-lg-3 col-md-6">
<!-- Footer Widget -->
<div class="footer-widget footer-menu">
<h2 class="footer-title">Medical Group</h2>
<ul>
<li><a href="#">Locations</a></li>
<li><a href="#">Doctors</a></li>
<li><a href="#">Telehealth Appointment</a></li>
<li><a href="#">Pay your Bill</a></li>
<li><a href="d#">Patients Resources</a></li>
</ul>
</div>
<!-- /Footer Widget -->
</div>
<div class="col-lg-3 col-md-6">
<!-- Footer Widget -->
<div class="footer-widget footer-contact">
<h2 class="footer-title">Contact Us</h2>
<div class="footer-contact-info">
<div class="footer-address">
<span><i class="fas fa-map-marker-alt"></i></span>
<p>OakBend Medical Center,<br>1705 Jackson Street, Richmond, Texas 77469 </p>
</div>
<p>
<i class="fas fa-phone-alt"></i>
+281-341-3000
</p>
<p class="mb-0">
<i class="fas fa-envelope"></i>
info@obmc.org
</p>
</div>
</div>
<!-- /Footer Widget -->
</div>
</div>
</div>
</div>
<!-- /Footer Top -->
<!-- Footer Bottom -->
<div class="footer-bottom">
<div class="container-fluid">
<!-- Copyright -->
<div class="copyright">
<div class="row">
<div class="col-md-6 col-lg-6">
<div class="copyright-text">
<p class="mb-0">© 2022 OakBend. All rights reserved.</p>
</div>
</div>
<div class="col-md-6 col-lg-6">
<!-- Copyright Menu -->
<div class="copyright-menu">
<ul class="policy-menu">
<li><a href="#">Refund Policy</a></li>
<li><a href="#">Privacy Policy</a></li>
<li><a href="#">Public Information Request</a></li>
</ul>
</div>
<!-- /Copyright Menu -->
</div>
</div>
</div>
<!-- /Copyright -->
</div>
</div>
<!-- /Footer Bottom -->
</footer>
<!-- /Footer -->
</div>
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<!-- jQuery -->
<script src="assets/js/jquery-3.6.0.min.js"></script>
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<!-- Custom JS -->
<script src="assets/js/script.js"></script>
</body>
</html>