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<?php $__env->startSection('title', 'Joruri Doctor | Signup for User'); ?>

<?php $__env->startSection('content'); ?> 
<main class="flex-shrink-0">
  	<div class="container mt-3">
	    <div class="row">
	    	<div class="col-md-2"></div>
	    	<div class="col-md-8">
	    		<label class="bg-danger text-white fw-bold" style="padding: 3px; border-radius: 0px 500mm 50mm 0px; width: 50%;">Patient Registration Form</label>
	    		<div class="card">
			        <div class="card-body">
			        	<?php if($errors->any()): ?>
						    <div class="alert alert-danger">
						        <ul>
						            <?php $__currentLoopData = $errors->all(); $__env->addLoop($__currentLoopData); foreach($__currentLoopData as $error): $__env->incrementLoopIndices(); $loop = $__env->getLastLoop(); ?>
						                <li><?php echo e($error); ?></li>
						            <?php endforeach; $__env->popLoop(); $loop = $__env->getLastLoop(); ?>
						        </ul>
						    </div>
						<?php endif; ?>
			            <form action="<?php echo e(route('store_user')); ?>" method="post" class="row g-3">
			            	<?php echo csrf_field(); ?>
			              	<div class="col-md-4 form-floating">
				                <input type="text" name="customer_name" placeholder="" class="form-control">
				                <label for="inputname">Full Name</label>
			              	</div>
			              	<div class="col-md-4 form-floating">
				                <input type="number" name="customer_mobile" placeholder="017000000000" class="form-control" maxlength="11" required>
				                <label for="inputmobile" class="form-label">Mobile Number</label>
				               
			              	</div>
			              	
			              	
			              	<div class="col-md-4 form-floating">
				                <select name="customer_gender" class="form-select" class="form-control" required>
				                	<option selected>Select Gender</option>
				                	<option value="Male">Male</option>
				                	<option value="Female">Female</option>
				                </select>
				                <label for="" class="form-label">Gender</label>
			              	</div>
			              	
			              	<div class="col-md-4 form-floating">
				                <input type="email" name="customer_email" placeholder="example@example.com" class="form-control" required>
				                <label for="inputemail" class="form-label">E-mail</label>
				                
			              	</div>
			              	<div class="col-md-4 form-floating">
				                <input type="password" name="password" placeholder="Password" class="form-control" minlength="8" required>
				                <label for="inputpassword" class="form-label">Password</label>
				                
			              	</div>
			              	<div class="col-md-4 form-floating">
				                <input type="password" name="password_confirmation" placeholder="Re-type Password" class="form-control" required>
				                <label for="inputpassword" class="form-label" minlength="8">Confirm Password</label>
				               
			              	</div>
				            <div class="col-md-3 form-floating">
				                <select id="division" name="division" class="form-select" class="form-control" required>
				                	<option selected>Select Division</option>
				               	<?php $__currentLoopData = $division; $__env->addLoop($__currentLoopData); foreach($__currentLoopData as $data): $__env->incrementLoopIndices(); $loop = $__env->getLastLoop(); ?>
				                  	<option value="<?php echo e($data->id); ?>"><?php echo e($data->name); ?></option>
				                <?php endforeach; $__env->popLoop(); $loop = $__env->getLastLoop(); ?>
				                </select>
				                <label for="" class="form-label">Division</label>
			              	</div>
			              	<div class="col-md-3 form-floating">
				                <select id="district" name="district" class="form-select" class="form-control" required>
				                  
				                </select>
				                <label for="" class="form-label">District</label>
			              	</div>
			              	<div class="col-md-3 form-floating">
				                <select id="upazila" name="upazila" class="form-select" class="form-control" required>
				                  
				                </select>
				                <label for="" class="form-label">Upazilla</label>
			              	</div>
			              	<div class="col-md-3 form-floating">
				                <select id="union" name="union" class="form-select" class="form-control" required>
				                  
				                </select>
				                <label for="union" class="form-label">Union</label>
			              	</div>
							<?php $__currentLoopData = $package; $__env->addLoop($__currentLoopData); foreach($__currentLoopData as $package): $__env->incrementLoopIndices(); $loop = $__env->getLastLoop(); ?>
				            <div class="col text-center">
			            		<div class="card text-white bd-yellow-500">
									<div class="card-header border-bd-blue-100" style="text-align: center;">
									  		<?php echo e($package->package_type); ?> Subscription
									</div>
									<ul class="list-group list-group-flush">
						                <li class="list-group-item">
						                	<i class="fas fa-money-bill"></i>
						                	Amount: <?php echo e($package->package_amount); ?> Tk</li>
						                <li class="list-group-item">
						                	<i class="fas fa-calendar-alt"></i>
						                	Valitidy: <?php echo e($package->package_duration); ?> Month</li>
						                <li class="list-group-item">
						                	<i class="fas fa-user-tag"></i>
						                	Discount: <?php echo e($package->package_discount); ?> Tk</li>
						            </ul>
								 	<div class="card-footer bg-transparent border-success" style="text-align: center; color:#820000; font-weight: bold;">TICK THE BOX <i class="fas fa-arrow-right"></i>
								  		<input class="form-check-input" type="checkbox" name="end_date" id="inputpackage" value="<?php $data = $package->package_duration; echo date('Y-m-d', strtotime('+'.$data. 'month'))?>" required>
								  		<input class="visually-hidden" name="sub_id" value="<?php echo e($package->id); ?>">
								  	</div>
				            	</div>
				            </div>
				            <?php endforeach; $__env->popLoop(); $loop = $__env->getLastLoop(); ?>

<div class="col-md-12">
			                	<button type="submit" class="btn btn-danger fw-bold d-grid gap-2 col-4 mx-auto">Register</button>
			              	</div>
			            </form>
			        </div>
			    </div>
	    	</div>
	    	<div class="col-md-2"></div>
	    </div>
	</div>
</main>
<?php $__env->stopSection(); ?>
<?php echo $__env->make('layouts.home_header', \Illuminate\Support\Arr::except(get_defined_vars(), ['__data', '__path']))->render(); ?><?php /**PATH /home/rejoandoctor/public_html/resources/views/Home/sign_up.blade.php ENDPATH**/ ?>