<div class="row">
<div class="col-md-12">
<div class="talk-doctor-wrap">
<div class="talk-doctor-img">
<figure><img alt="doctor" src="https://www.cureindia.com/images/talk-doctor.webp" /></figure>
</div>

<div class="talk-doctor-info">
<h3>ДАВАЙТЕ СПЛАНИРУЕМ ВАШЕ</h3>

<h2>ЛЕЧЕНИЕ В ИНДИИ</h2>

<form action="ajax/planTreatment.php" id="plan-treatment-form-1" method="post">
<div class="input-group"><input name="plan_email" placeholder="Ваш адрес электронной почты" type="email" /></div>

<div class="col-md-12">
<div class="form-field">
<div class="col-md-5"><input class="form-control mobile-number" id="mobile_code_1" name="mobile_code" placeholder="+91, +1" readonly="readonly" style="width: 100%;float:left;" type="tel" /></div>

<div class="col-md-7"><input class="form-control" id="app_mobile_code_1" name="app_mobile_code" placeholder="Номер телефона" type="text" /></div>
</div>
</div>
<input id="g-recaptcha-response-plan-treatment-1" name="g-recaptcha-response-plan-treatment" type="hidden" />
<div class="input-group"><input id="plan-treatment-submit-1" name="plan-treatment-submit" type="submit" value="Поговорить С Врачом" /></div>

<div class="text-align-center"><img height="40px" id="plan-treatment-loader-1" src="https://www.cureindia.com/images/loader-40x40.gif" style="height: 40px;display:none;" width="40px" /></div>
</form>

<div class="response-message" id="form-response-1" style="margin-top: 20px;">&nbsp;</div>
</div>
</div>
</div>
</div>