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编辑当前文件:/home/rejoandoctor/www/resources/views/Prescribe/add_doctor.blade.php

@extends('layouts.app')

@section('title', 'Joruri Doctor | Dr Registration')
 
@section('content')

<div class="main-content">
  <div class="main-content-inner">
      <div class="breadcrumbs ace-save-state" id="breadcrumbs">
        @include('layouts.header_menu')
      </div>

<div class="page-content">
          <div class="row">
             <div class="col-xs-12">
              <div class="row">
                <div class="col-sm-3"></div>
                  <div class="col-sm-6">
                    <div class="widget-box">
                      <div class="widget-header">
                        <h4 class="widget-title">Doctor Registration</h4>
                        <div class="widget-toolbar">
                          <a href="#" data-action="collapse">
                            <i class="ace-icon fa fa-chevron-up"></i>
                          </a>

<a href="#" data-action="close">
                            <i class="ace-icon fa fa-times"></i>
                          </a>
                        </div>
                      </div>
                      <div class="widget-body">
                        <div class="widget-main">
                         
                          <form action="{{route('store_doctor')}}" method="POST">
                            @csrf

<label for="form-field-8"><span class="label label-lg label-pink arrowed-right">Select Package First</span></label>
                            
                            <div class="form-group">
                              <input class="form-control" type="number" name="monthly_charge" value="{{Request::segment(4)}}" placeholder="Select Package" readonly>
                            </div>
                            <div class="form-group">
                              <input class="form-control" type="text" name="end_date" id="c_date" value="@php $data = Request::segment(3); echo date('Y-m-d', strtotime('+'.$data. 'month'))@endphp" readonly>
                            </div>

<div class="form-inline center">
                              <div class="form-group">
                                <div class="radio">
                                  <label>
                                    <input name="doctor_type" type="radio" value="MBBS" class="ace">
                                    <span class="lbl"> MBBS </span>
                                  </label>
                                </div>
                                 
                                 
                                <div class="radio">
                                  <label>
                                    <input name="doctor_type" type="radio" value="BDS" class="ace">
                                    <span class="lbl"> BDS </span>
                                  </label>
                                </div>
                                 
                                 
                                <div class="radio">
                                  <label>
                                    <input name="doctor_type" type="radio" value="DMF" class="ace">
                                    <span class="lbl"> DMF </span>
                                  </label>
                                </div>
                              </div>
                              <div class="form-group">
                                <select name="additional_degree" class="chosen-select form-control"data-placeholder="Aditional Degree..." autocomplete="off" required>
                                  <option>Select Aditional Degree</option>
                                  <option value="FCPS">FCPS</option>
                                  <option value="MD">MD</option>
                                  <option value="FCPS,MD">FCPS,MD</option>
                                </select>
                              </div>
                            </div>

<input type="email" id="form-field-1" placeholder="Doctor Email" class="form-control" name="customer_email">
                              @error('customer_email')
                                <span class="invalid-feedback" role="alert">
                                    <strong style="color: red;">{{ $message }}</strong>
                                </span>
                              @enderror
                            </div>

<div class="form-group">
                              <input type="password" id="form-field-1" placeholder=" Password" class="form-control" name="password" autocomplete="off">
                              @error('password')
                                <span class="invalid-feedback" role="alert">
                                    <strong style="color: red;">{{ $message }}</strong>
                                </span>
                              @enderror
                            </div>

<div class="form-group">
                              <input type="password" id="form-field-1" placeholder="Confirm Password" class="form-control" name="password_confirmation" autocomplete="off">
                              @error('password_confirmation')
                                <span class="invalid-feedback" role="alert">
                                    <strong style="color: red;">{{ $message }}</strong>
                                </span>
                              @enderror
                            </div>
                           
                            <div class="form-group">

<input type="text" id="form-field-1" placeholder="Doctor Name" class="form-control" name="customer_name">
                              @error('customer_name')
                                <span class="invalid-feedback" role="alert">
                                    <strong style="color: red;">{{ $message }}</strong>
                                </span>
                              @enderror
                            </div>

<div class="form-group">
                              <input type="number" id="form-field-1" placeholder="Doctor Mobile" class="form-control" name="customer_mobile" maxlength="11">
                               @error('customer_mobile')
                                <span class="invalid-feedback" role="alert">
                                    <strong style="color: red;">{{ $message }}</strong>
                                </span>
                              @enderror
                            </div>

<div class="form-group">
                              <input type="text" id="form-field-1" placeholder="Doctor Especial Course" class="form-control" name="course">
                            </div>
                           
                            <div class="form-group">
                              <select name="doctor_specialist" class="chosen-select form-control"data-placeholder="Specialist..." autocomplete="off" required>
                                <option>Select Specialist</option>
                                @foreach ($specialist as $result)
                                  <option value="{{$result->specialist}}">{{$result->specialist}}</option>
                                @endforeach
                              </select>
                            </div>

<div class="form-group">
                              <select class="chosen-select form-control" data-placeholder="Chamber Area..." name="chamber_area" autocomplete="off" required>
                                <option>Select Chamber Area</option>
                                @foreach($upazilas as $upazilas)
                                  <option value="{{$upazilas->id}}">{{$upazilas->name}} - {{$upazilas->url}}</option>
                                @endforeach
                              </select>

</div>
                           
                          
                            <div class="form-actions center">
                              <button class="btn btn-warning btn-round" type="submit">Doctor Registration</button>
                            </div>

</form>
                        </div>
                      </div>
                    </div>
                  </div>
                <div class="col-sm-3"></div>
              </div>
@endsection