Code: 👇

                            <!-- HTML -->
                            
          <p class="rul_1">Важливо! CardiHeal вже закінчується!</p>

<p class="rul_1">На даний момент залишилося упаковок:</p>

<h3 class="left_count" style="cursor: pointer"><b class="prod_left_val">414</b> шт.</h3>

<h4 class="rul_3"></h4>

<span id="cta"></span>
<span id="form"></span>

<div id="b-quiz">
    <div class="quiz_wrap">
        <div class="quiz_header">
            <div class="quiz_title">Відповідайте на 4 запитання <br>
                і отримайте CardiHeal по акції <span>БЕЗКОШТОВНО!</span></div>
            <div class="order_title">Дякую за відповіді! <br> Заповніть поля нижче <br>
                та натисніть <br>
                <span>«ОТРИМАТИ CardiHeal»</span>
            </div>
        </div>
        <div class="quiz_body">
            <quiz class="quiz_step active" style="display: block;">
                <div class="quiz_question">
                    <div>
                        <span></span>
                        Скільки Вам років?
                    </div>
                </div>
                <div class="quiz_options">
                    <div class="quiz_option">18-24</div>
                    <div class="quiz_option">25-34</div>
                    <div class="quiz_option">35-44</div>
                    <div class="quiz_option">45-54</div>
                    <div class="quiz_option">55+</div>
                </div>
            </quiz>
            <quiz class="quiz_step">
                <div class="quiz_question">
                    <div>
                        <span></span>
                        Чи маєте Ви головний біль або запаморочення?
                    </div>
                </div>
                <div class="quiz_options">
                    <div class="quiz_option">ТАК</div>
                    <div class="quiz_option">НІ</div>
                </div>
            </quiz>
            <quiz class="quiz_step">
                <div class="quiz_question">
                    <div>
                        <span></span>
                        Чи маєте Ви проблеми зі сном?
                    </div>
                </div>
                <div class="quiz_options">
                    <div class="quiz_option">ТАК</div>
                    <div class="quiz_option">НІ</div>
                </div>
            </quiz>
            <quiz class="quiz_step">
                <div class="quiz_question">
                    <div>
                        <span></span>
                        Який тиск ви маєте?
                    </div>
                </div>
                <div class="quiz_options">
                    <div class="quiz_option">Низький</div>
                    <div class="quiz_option">Високий</div>
                </div>
            </quiz>
            <div class="quiz_step quiz_form">
                <div class="quiz_timer">
                    Акція завершиться через:
                    <div><span id="mins">10</span> хв : <span id="secs">00</span> сек</div>
                </div>
                <div class="quiz_prices">
                    <div class="quiz_newprice"><span class="order__price-summ price_land_s1"></span><span class="order__price-zero hidden-pzero"></span><span class="order__price-curr price_land_curr">ПО АКЦІЇ БЕЗКОШТОВНО</span></div>
                </div>


                <form id="order_form" autocomplete="off" action="api/send.php" method="post">
                    
                    <input type="text" name="fullName" placeholder="Ваше ім'я" required="required" minlength="2">
                    <label style="font-size: 15px;display:block;text-align:center" for="">Наприклад: +38 (095) 333-22-22</label>
                    <input type="tel" id="phone" name="phoneNumber"  placeholder="Ваш телефон" required="required"  placeholder="Ваш телефон">
                    <button type="submit">ОТРИМАТИ ПО АКЦІЇ*</button>

                    <input
                            type="hidden"
                            name="country"
                            value="PL" />
                        <input
                            type="hidden"
                            name="language"
                            value="pl" />
                        <input
                            type="hidden"
                            name="offer_id"
                            value="{offer_id}" />
                        <input
                            type="hidden"
                            name="subid"
                            value="{subid}" />

                            
                            <input type="hidden" name="offer_title" value="Oculax" />  
                            <input type="hidden" name="niche" value="vision">
                </form>


                <center>
                    <center>*при замовленні курсу</center>
                </center>
            </div>
        </div>
        <div class="quiz_nums">
            <div class="quiz_num active"><span>1</span></div>
            <div class="quiz_num"><span>2</span></div>
            <div class="quiz_num"><span>3</span></div>
            <div class="quiz_num"><span>4</span></div>
        </div>
        <div class="quiz_footer">
            Залишилось упаковок по акції: <span> <span class="prod_left_val">414</span>&nbsp;шт.</span>
        </div>
    </div>
</div>
                            
                            
                            
       <!-- CSS -->
                            
     
#b-quiz * {
	box-sizing: border-box;
}

#b-quiz .quiz_form form input {
	line-height: 0px !important;
}


#b-quiz .quiz_wrap * {
	font-family: "Arial";
}

#b-quiz .quiz_wrap {
	position: relative;
	margin: 20px auto;
	max-width: 427px;
	width: 100%;
	height: 610px;
	border-radius: 20px;
	background-color: #F4F6F5;
	overflow: hidden;


}

#b-quiz .quiz_header {
	background-color: #212121;
	position: relative;
	border-radius: 20px 20px 50% 50%;
	padding-bottom: 43px;
}

#b-quiz .quiz_header:after {
	content: " ";
	display: block;
	position: absolute;
	bottom: -27px;
	height: 27px;
	width: 100%;
}

#b-quiz .quiz_title {
	padding-top: 20px;
	font-style: normal;
	font-weight: 700;
	font-size: 20px;
	line-height: 135%;
	text-align: center;
	color: #fff;
}

#b-quiz .quiz_title span {
	color: #FD0638;
	display: block;
	margin-top: 5px;
	font-weight: 800;
	font-size: 22px;
	line-height: 135%;
}

#b-quiz .order_title {
	display: none;
	font-style: normal;
	font-weight: 700;
	font-size: 18px;
	line-height: 135%;
	text-align: center;
	color: #fff;
	text-shadow: 0 1px 1px rgba(0, 0, 0, 0.7);
	padding-top: 17px;
}

#b-quiz .order_title span {
	color: white;
	font-size: 20px;
	display: block;
	margin-top: 4px;
}

#b-quiz .quiz_question {
	display: flex;
	align-items: center;
	height: 48px;
	margin: 48px 38px 20px;
	font-style: normal;
	font-weight: 700;
	font-size: 18px;
	line-height: 133%;
	color: #000;
}

#b-quiz .quiz_question div {
	display: flex;
}

#b-quiz .quiz_question div span {
	display: block;
	padding-right: 8px;
}

#b-quiz .quiz_options {
	margin: 0 34px;
}

#b-quiz .quiz_option {
	position: relative;
	padding-left: 40px;
	font-style: normal;
	font-weight: 600;
	font-size: 18px;
	margin-bottom: 21px;
	line-height: 135%;
	cursor: pointer;
	color: #000;
}

#b-quiz .quiz_option:before {
	-webkit-transition: .2s all;
	transition: .2s all;
	content: ' ';
	display: block;
	background: #B9B9B9;
	width: 24px;
	height: 24px;
	border-radius: 50%;
	border: 1px solid #959595;
	position: absolute;
	left: 0;
	top: -2px;
}

#b-quiz .quiz_option:after {
	-webkit-transition: .2s all;
	transition: .2s all;
	content: ' ';
	display: block;
	background-color: #FD0638;
	height: 14px;
	width: 14px;
	border-radius: 50%;
	position: absolute;
	left: 6px;
	top: 4px;

	opacity: 0
}

#b-quiz .quiz_option.active:before {
	animation: radial-pulse 0.5s;
}

@keyframes radial-pulse {
	0% {
		box-shadow: 0 0 1px 2px #7931b1;
	}

	100% {
		box-shadow: 0 0 4px 5px rgba(0, 0, 0, 0);
	}
}

#b-quiz .quiz_option:hover:before,
#b-quiz .quiz_option.active:before {
	border: 1px solid #7931b1;
}

#b-quiz .quiz_option:hover:after,
#b-quiz .quiz_option.active:after {
	opacity: 1;
}

#b-quiz .quiz_nums {
	padding: 0 32px;
	width: 100%;
	display: flex;
	justify-content: space-between;
	position: absolute;
	bottom: 65px;
}

#b-quiz .quiz_num {
	-webkit-transition: 1s all;
	transition: 1s all;
	font-style: normal;
	font-weight: 600;
	font-size: 20px;
	line-height: 100%;
	position: relative;
	display: flex;
	align-items: center;
	justify-content: center;
	border-radius: 50%;
	width: 44px;
	height: 44px;
	background: #D9D9D9;
	border: 1px solid #fff;
	color: #000;
}

#b-quiz .quiz_num span {
	-webkit-transition: 1s all;
	transition: 1s all;
	display: flex;
	align-items: center;
	justify-content: center;
	height: 43px;
	width: 56px;
	background: #D9D9D9;
	border-radius: 50%;
}

#b-quiz .quiz_num.active {
	background: #e5d2f2;
	border: 1px solid #a260d4;
}

#b-quiz .quiz_num.active span {
	background: #000;
	color: #fff;
}

#b-quiz .quiz_nums:before {
	content: '';
	display: block;
	position: absolute;
	top: 50%;
	width: calc(100% - 64px);
	height: 1px;
	background: #000;
}

#b-quiz .quiz_footer {
	width: 100%;
	position: absolute;
	bottom: 20px;
	color: #000;
	text-align: center;
	font-weight: 400;
	font-size: 14px;
	line-height: 17px;
}


#b-quiz .quiz_step,
#b-quiz #prod_img {
	transition: 0.5s all;
	display: none;
	opacity: 0;
	margin-top: -7px;
}

#b-quiz .quiz_step.active,
#b-quiz #prod_img.active {
	opacity: 1;
	margin-top: 0;
}

#b-quiz .quiz_timer {
	margin-top: 39px;
	text-align: center;
	font-style: normal;
	font-weight: 400;
	font-size: 16px;
	line-height: 20px;
	text-align: center;
	color: #000;
}

#b-quiz .quiz_timer div {
	margin-top: 4px;
	font-style: normal;
	font-weight: 600;
	font-size: 22px;
	line-height: 27px;
	text-align: center;
	color: #FD0638;
	text-align: center;
}

#b-quiz .quiz_timer span {
	display: inline-block;
	width: 32px;
}

#b-quiz .quiz_prices {
	margin-top: 16px;
	margin-bottom: 12px;
	text-align: center;
}

#b-quiz .quiz_prices .quiz_oldprice {
	font-style: normal;
	font-weight: 600;
	font-size: 18px;
	line-height: 22px;
	text-align: center;
	text-decoration-line: line-through;
	color: #000;
}



#b-quiz .quiz_form form {
	width: 280px;
	margin: 0 auto;
}

#b-quiz .quiz_form form input {
	line-height: 48px;
	padding: 12px 24px;
	font-style: normal;
	font-weight: 400;
	font-size: 18px;
	display: block;
	background: #fff;
	border: 1px solid #5a1784;
	border-radius: 24px;
	width: 100%;
	margin-bottom: 16px;
	position: relative;
}

#b-quiz .quiz_form form input.active:invalid {
	border: 1px solid red;
}

#b-quiz .quiz_form form input.active:valid,
#b-quiz .quiz_form form input.active:-webkit-autofill:valid,
#b-quiz .quiz_form form input.active:-webkit-autofill:hover:valid,
#b-quiz .quiz_form form input.active:-webkit-autofill:focus:valid,
#b-quiz .quiz_form form input.active:-webkit-autofill:active:valid {
	border: 1px solid #68c853;
	background-color: #fff !important;
	background-repeat: no-repeat;
	background-size: 16px 12px;
	background-position: top 50% right 16px;
}

#b-quiz .quiz_form form button {
	text-transform: uppercase;
	margin-top: 24px;
	border-radius: 24px;
	height: 48px;
	display: block;
	text-align: center;
	width: 100%;
	background: #FD0638;
	font-style: normal;
	font-weight: 700;
	font-size: 16px;
	line-height: .5;
	letter-spacing: 0.03em;
	border: none;
	color: #fff;
	cursor: pointer;
}

#b-quiz .order__price-curr {
	color: #FD0638;
	font-weight: bold;
}

@media (max-width: 360px) {
	#b-quiz .quiz_question {
		margin: 48px 18px 20px;
	}

	#b-quiz .quiz_options {
		margin: 0 14px;
	}
}

p.rul_1 {
    text-align: center;
    color: red;
    font-weight: bold;
    padding: 0;
    font-size: 120%;
	margin-bottom: 20px;
}
h4.rul_3 {
    text-align: center;
    color: green;
    font-weight: bold;
    padding: 0;
    font-size: 110%;
}
p.rul_2 {
    text-align: center;
    font-weight: bold;
    font-size: 120%;
}

													


.js_old_price {
    display: block;
    margin: 0 auto;
}

.price_main {
    border-bottom: 2px solid #d31812;
    font-size: 24px;
    line-height: 0px;
    margin: 0 auto;
}
b, strong {
    font-weight: bolder;
}
 
 
.prod_img_wrapper {

    max-width: 300px;
    margin: 15px auto;
    position: relative;
}


.js_old_price {
    display: block;
    margin: 0 auto;
}

.price_main {
    border-bottom: 2px solid #d31812;
    font-size: 24px;
    line-height: 0px;
    margin: 0 auto;
}
.span-input-roulette.phone_in:before {
    content: 'Введите Номер телефона';
}

.span-input-roulette:before {
    display: inline-block;
    color: #333;
    line-height: 47px;
    position: absolute;
    top: -35px;
    font-size: 95%;
    left: 5px;
}

input-roulette {
    padding-left: 5px;
    height: 42px;
    margin-bottom: 10px;
    width: 100%;
    border: 2px solid grey;
    border-radius: 5px;
    max-width: 450px;
    -webkit-box-sizing: border-box;
    box-sizing: border-box;
}
input {
    outline: none;
}

input.submit-roulette {
    text-transform: uppercase;
    padding: 10px 30px;
    margin: 15px 0;
    outline: none;
    border: none;
    margin-top: 5px;
    border-radius: 5px;
    background: #ff0000f7;
    color: #fff;
    font-weight: bold;
    cursor: pointer;
    -webkit-transition: background 0.3s;
    transition: background 0.3s;
    width: 450px;
    max-width: 100%;
    -webkit-appearance: 5px;
    -webkit-border-radius: 5px;
}

.span-input-roulette {
    position: relative;
    display: block;
    margin-top: 20px;
    width: 100%;
    max-width: 450px;
}.span-input-roulette.name_in:before {
    content: 'Введите Имя';
}

.span-input-roulette {
    position: relative;
    display: block;
    margin-top: 20px;
    width: 100%;
    max-width: 450px;
}.input-roulette {
    padding-left: 5px;
    height: 42px;
    margin-bottom: 10px;
    width: 100%;
    border: 2px solid grey;
    border-radius: 5px;
    max-width: 450px;
    -webkit-box-sizing: border-box;
    box-sizing: border-box;
}


.span-input-roulette:before {
    display: inline-block;
    color: #333;
    line-height: 47px;
    position: absolute;
    top: -35px;
    font-size: 95%;
    left: 5px;
}.priceс {
    position: absolute;
    font-family: 'Arial', sans-serif;
    right: 0;
    bottom: 0;
    color: #000;
    -webkit-box-shadow: rgb(0 0 0 / 80%) 0px 3px 30px;
    box-shadow: rgb(0 0 0 / 80%) 0px 3px 30px;
    width: 165px;
    height: 98px;
    text-align: center !important;
    font-size: 19px;
    font-weight: bold;
    line-height: 1.3;
    -webkit-transform: rotateZ(
-7deg
);
    transform: rotateZ(
-7deg
);
    margin: -0px auto 0px;
    background: -webkit-gradient(linear, left top, right top, from(rgb(238, 165, 19)), to(rgb(253, 237, 19)));
    background: linear-gradient(to right, rgb(238, 165, 19) 0%, rgb(253, 237, 19) 100%);
    border-width: 2px;
    border-style: solid;
    border-color: rgb(255, 255, 255);
    -o-border-image: initial;
    border-image: initial;
    border-radius: 19%;
}



.price_main {
    border-bottom: 2px solid #d31812;
    font-size: 24px;
    line-height: 0px;
    margin: 0 auto;
}

span.discountс {
    display: block;
    margin-top: 4px;
    font-size: 16px;
}

.js_old_price {
    display: block;
    margin: 0 auto;
}

.price_main {
    border-bottom: 2px solid #d31812;
    font-size: 24px;
    line-height: 0px;
    margin: 0 auto;
}
@-webkit-keyframes super-rotation {
    70% {
        -webkit-transform: rotate(1660deg);
        transform: rotate(1660deg);
    }

    100% {
        -webkit-transform: rotate(1620deg);
        transform: rotate(1620deg);
    }
}

@keyframes super-rotation {
    70% {
        -webkit-transform: rotate(1660deg);
        transform: rotate(1660deg);
    }

    100% {
        -webkit-transform: rotate(1620deg);
        transform: rotate(1620deg);
    }
}


.mgr {
    color: mediumseagreen;
}

.gr {
    color: green;
}

.red {
    color: red;
}

.ub {
    text-decoration: underline;
    font-weight: bold;
}

.ct {
    text-align: center;
}
 
.cti {
    text-align: center;
    font-style: italic;
}

.ctu {
    text-align: center;
    text-decoration: underline;
}

h2 {
line-height: 30px;
}

@media screen and (max-width:365px) {
    .header__logo .spec
    { display: none;
    }
}

.left_count {
    line-height: 1;
    -webkit-box-sizing: border-box;
    box-sizing: border-box;
    display: table;
    text-align: center;
    padding: 0px 20px 10px 20px;
    background: red;
    margin: 12px auto;
    color: #fff;
    text-shadow: 0 -1px 0 #000000, 0 -1px 0 #000000, 0 1px 0 #000000, 0 1px 0 #000000, -1px 0 0 #000000, 1px 0 0 #000000, -1px 0 0 #000000, 1px 0 0 #000000, -1px -1px 0 #000000, 1px -1px 0 #000000, -1px 1px 0 #000000, 1px 1px 0 #000000, -1px -1px 0 #000000, 1px -1px 0 #000000, -1px 1px 0 #000000, 1px 1px 0 #000000;
    font-size: 130% !important;
    border-radius: 5px;
}

.left_count .prod_left_val {
    font-size: 52px !important;
}


  <!-- JS -->

  "use strict";

function numOfProd() {
 function e(e) {
  (e = (e = +$(".prod_left_val").html() - e) < 5 ? 5 : e),
   $(".prod_left_val").html(e);
 }
 setTimeout(function () {
  e(2),
   setInterval(function () {
    e(Math.floor(2 * Math.random()) + 2);
   }, 1e3 * (Math.floor(5 * Math.random()) + 20));
 }, 2e3);
}
window.addEventListener("DOMContentLoaded", () => {
 let o,
  l = 0,
  n = 600;

 function c() {
  --n;
  let e = Math.floor(n / 60),
   t = n - 60 * e;
  0 == e && 0 == t && clearInterval(o),
   (t = 10 <= t ? t : "0" + t),
   (e = 10 <= e ? e : "0" + e),
   (document.querySelector("#mins").innerHTML = e),
   (document.querySelector("#secs").innerHTML = t);
 }
 const e = document.querySelectorAll(".quiz_option"),
  t = document.querySelectorAll(".quiz_step"),
  r = document.querySelectorAll(".quiz_num"),
  i = document.querySelectorAll(".quiz_form form input");
 let s = !1;
 e.forEach((e) => {
  e.addEventListener("click", () => {
   s ||
    ((s = !0),
    l++,
    e.classList.add("active"),
    setTimeout(() => {
     t.forEach((e, t) => {
      t == l
       ? ((e.style.display = "block"),
        setTimeout(() => {
         e.classList.add("active");
        }, 400),
        4 == l
         ? ((document.querySelector(".quiz_nums").style.display =
           "none"),
          (document.querySelector(".quiz_title").style.display =
           "none"),
          (document.querySelector(".order_title").style.display =
           "block"),
          (o = setInterval(c, 1e3)),
          document.querySelector("#prod_img")
           ? (document.querySelector("#prod_img").style.display =
             "block")
           : console.log(""),
          setTimeout(() => {
           document.querySelector("#prod_img")
            ? document
              .querySelector("#prod_img")
              .classList.add("active")
            : console.log(""),
            setTimeout(() => {
             var e = $("#b-quiz"),
              e = $(e).offset().top;
             $("body,html").animate(
              {
               scrollTop: e,
              },
              777
             );
            }, 200);
          }, 400))
         : r[l].classList.add("active"))
       : (e.classList.remove("active"),
        setTimeout(() => {
         e.style.display = "none";
        }, 400));
     }),
      (s = !1);
    }, 400));
  });
 }),
  i.forEach((e) => {
   e.addEventListener("focus", () => {
    e.classList.add("active");
   });
  });
}),

 numOfProd();