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@extends('layouts.master') @section('page-title') Create Practice @endsection @section('content') <div class="right_col" role="main"> <div> <div class="page-title"> <div class="title_left"> <h3>Create Practice</h3> </div> <div class="title_right"> <div class="col-md-5 col-sm-5 col-lg-12 form-group text-right top_search"> <a href="{{ route('practices.index') }}" class="btn btn-primary">Back</a> </div> </div> </div> <div class="clearfix"></div> <div class="row"> <div class="col-md-12 "> <div class="x_panel"> <div class="x_content"> <br /> <form action="{{ route('practices.store') }}" method="POST" enctype="multipart/form-data"> @csrf <div class="row"> <div class="col-md-12 col-sm-12 col-12"> <div class="main-flex-cls"> <div class="field-cls"> <label class="label-text" for="name">Name</label> <input type="text" id="name" name="name" value="{{ old('name') }}" class="form-control" placeholder="Name" required> </div> </div> </div> </div> <div class="row"> <div class="col-md-12 col-sm-12 col-12"> <div class="main-flex-cls" style="align-items: unset;"> <div class="field-cls"> <label class="label-text" for="email">Email</label> <input type="email" id="email" name="email" value="{{ old('email') }}" class="form-control" placeholder="Email" required> </div> <div class="field-cls"> <label class="label-text" for="phone">Phone</label> <input type="text" id="phone" name="phone" value="{{ old('phone') }}" class="form-control" placeholder="Phone" required> </div> <div class="field-cls"> <label class="label-text" for="phone"> Other Emails </label> <input type="text" id="phone" autocomplete="off" name="other_emails" value="{{ $practice->other_emails }}" class="form-control" placeholder="abc@email.com,xyz@email.com"> <div class=""> <small>Multiple emails can be send by using a comma between emails.</small> </div> </div> </div> </div> </div> <div class="row"> <div class="col-md-12 col-sm-12 col-12"> <div class="main-flex-cls"> <div class="field-cls"> <label class="label-text" for="address">Address</label> <input type="text" id="address" name="address" value="{{ old('address') }}" class="form-control" placeholder="Street address" required> </div> <div class="field-cls"> <label class="label-text" for="address_2"> </label> <input type="text" id="address_2" name="address_2" value="{{ old('address_2') }}" class="form-control" placeholder="Street address line 2"> </div> </div> </div> </div> <div class="row"> <div class="col-md-12 col-sm-12 col-12"> <div class="main-flex-cls"> <div class="field-cls"> <input type="text" id="city" name="city" value="{{ old('city') }}" class="form-control" placeholder="City" required> </div> <div class="field-cls"> <input type="text" id="state" name="state" value="{{ old('state') }}" class="form-control" placeholder="State" required> </div> <div class="field-cls"> <input type="text" id="zip_code" name="zip_code" value="{{ old('zip_code') }}" class="form-control" placeholder="Postal code"> </div> </div> </div> </div> <div class="row"> <div class="col-md-12 col-sm-12 col-12"> <div class="modal-speciality"> <label>Speciality</label> {{-- <ul class="speciality-listing-content"> <li class="speciality-listing"><span><i class="fa fa-times" aria-hidden="true"></i> Pediatric</span></li> <li class="speciality-listing"><span><i class="fa fa-times" aria-hidden="true"></i> Oral Surgeon</span></li> <li class="speciality-listing"><span><i class="fa fa-times" aria-hidden="true"></i> Periodontist</span></li> <li class="speciality-listing"><span><i class="fa fa-times" aria-hidden="true"></i> Oral Pathologist</span></li> </ul> --}} <select name="speciality[]" id="speciality" class="form-control @error('speciality') is-invalid @enderror" required multiple> @foreach ($specialities as $speciality) <option value="{{ $speciality->id }}">{{ $speciality->title }} </option> @endforeach </select> </div> </div> </div> <div class="row"> <div class="col-md-12 col-sm-12 col-12"> <div class="main-flex-cls"> <div class="field-cls"> <label class="label-text" for="hours">Opening Hours</label> @php $days = ['Monday', 'Tuesday', 'Wednesday', 'Thursday', 'Friday', 'Saturday', 'Sunday']; @endphp @for ($i = 0; $i <= 6; $i++) <div class="col-md-12 row mb-3"> <div class="col-md-3 text-md-end">{{ $days[$i] }}: </div> <div class="col-md-1"> <input type="checkbox" name="check_{{ $i }}" id="check_{{ $i }}" class="js-switch" data-id="{{ $i }}"> </div> <div class="col-md-4"> <input type="text" id="opening_hour_{{ $i }}" class="form-control opening_hour" name="opening_hour_{{ $i }}" readonly placeholder="Opening Time"> </div> <div class="col-md-4 "> <input id="closing_hour_{{ $i }}" type="text" class="form-control closing_hour" name="closing_hour_{{ $i }}" readonly placeholder="Closing Time"> </div> </div> @endfor </div> </div> </div> </div> <div class="row upload-img-div"> <div class="col-md-5 col-sm-5 col-12"> <div class="col-ting"> <div class="control-group file-upload" id="file-upload1"> <h6 class="upload-pro-img">Upload Profile Image</h6> <div class="image-box text-center"> <p>Choose Image</p> <img src="" alt=""> </div> <div class="controls" style="display: none;"> <input type="file" id="profile_name" name="profile_name" required> </div> </div> </div> </div> <div class="col-md-7 col-sm-7 col-12"> </div> </div> <div class="row"> <div class="col-md-12 col-sm-12 col-12"> <div class="main-flex-cls"> <div class="field-cls"> <label class="label-text">Description</label> <textarea cols="4" rows="10" class=""></textarea> </div> </div> </div> </div> <div class="signup-btn submit-modal-btn"> <button type="submit" class="btn btn-primary">Submit</button> </div> </form> {{-- <form class="form-horizontal form-label-left" action="{{ route('practices.store') }}" method="POST" enctype="multipart/form-data"> @csrf <div class="row mb-2"> <label for="name" class="col-md-12 col-form-label text-md-end">{{ __('Name') }}</label> <div class="col-md-12"> <input id="name" type="text" class="form-control @error('name') is-invalid @enderror" name="name" value="{{ old('name') }}" required placeholder="John" autocomplete="name" autofocus> </div> </div> <input type="hidden" value="1"> <div class="row mb-3"> <label for="address" class="col-md-6 col-form-label text-md-end">{{ __('Email') }}</label> <label for="address" class="col-md-6 col-form-label text-md-end">{{ __('Phone') }}</label> <div class="col-md-6"> <input id="address" type="text" class="form-control @error('address') is-invalid @enderror" name="address" value="{{ old('address') }}" required placeholder="Street Address " autocomplete="address" autofocus> @error('address') <span class="invalid-feedback" role="alert"> <strong>{{ $message }}</strong> </span> @enderror </div> <div class="col-md-6"> <input id="address_2" type="text" class="form-control @error('address_2') is-invalid @enderror" name="address_2" value="{{ old('address_2') }}" placeholder="Street address line 2 " autocomplete="address_2" autofocus> @error('address_2') <span class="invalid-feedback" role="alert"> <strong>{{ $message }}</strong> </span> @enderror </div> </div> <div class="row mb-3"> <label for="address" class="col-md-12 col-form-label text-md-end">{{ __('Address') }}</label> <div class="col-md-6"> <input id="address" type="text" class="form-control @error('address') is-invalid @enderror" name="address" value="{{ old('address') }}" required placeholder="Street Address " autocomplete="address" autofocus> @error('address') <span class="invalid-feedback" role="alert"> <strong>{{ $message }}</strong> </span> @enderror </div> <div class="col-md-6"> <input id="address_2" type="text" class="form-control @error('address_2') is-invalid @enderror" name="address_2" value="{{ old('address_2') }}" placeholder="Street address line 2 " autocomplete="address_2" autofocus> @error('address_2') <span class="invalid-feedback" role="alert"> <strong>{{ $message }}</strong> </span> @enderror </div> </div> <div class="row mb-3"> <div class="col-md-4"> <input id="city" type="text" class="form-control @error('city') is-invalid @enderror" name="city" value="{{ old('city') }}" placeholder="Enter City" autocomplete="city" autofocus> @error('city') <span class="invalid-feedback" role="alert"> <strong>{{ $message }}</strong> </span> @enderror </div> <div class="col-md-4"> <input id="state" type="text" class="form-control @error('state') is-invalid @enderror" name="state" value="{{ old('state') }}" placeholder="Enter State" autocomplete="state" autofocus> @error('state') <span class="invalid-feedback" role="alert"> <strong>{{ $message }}</strong> </span> @enderror </div> <div class="col-md-4"> <input id="zip_code" type="text" class="form-control @error('zip_code') is-invalid @enderror" name="zip_code" value="{{ old('zip_code') }}" placeholder="Zipcode" autocomplete="zip_code" autofocus placeholder="Zip Code"> @error('zip_code') <span class="invalid-feedback" role="alert"> <strong>{{ $message }}</strong> </span> @enderror </div> </div> <div class="row mb-3"> <label for="speciality" class="col-md-12 col-form-label text-md-end">{{ __('Speciality') }}</label> <div class="col-md-12"> <select name="speciality[]" id="speciality" class="form-control @error('speciality') is-invalid @enderror" required multiple> @foreach ($specialities as $speciality) <option value="{{ $speciality->id }}">{{ $speciality->title }} </option> @endforeach </select> @error('speciality') <span class="invalid-feedback" role="alert"> <strong>{{ $message }}</strong> </span> @enderror </div> </div> <div class="row mb-3"> <label for="profile" class="col-md-12 col-form-label text-md-end">{{ __('Upload Profile Image') }}</label> <div class="col-md-12"> <input id="profile_name" type="file" class="form-control @error('profile_name') is-invalid @enderror" name="profile_name" value="{{ old('profile_name') }}" placeholder="Zipcode" required autocomplete="profile_name"> @error('description') <span class="invalid-feedback" role="alert"> <strong>{{ $message }}</strong> </span> @enderror </div> </div> <div class="row mb-3"> <label for="description" class="col-md-12 col-form-label text-md-end">{{ __('Description') }}</label> <div class="col-md-12"> <textarea id="description" type="text" class="form-control @error('description') is-invalid @enderror" name="description" required autocomplete="description" autofocus placeholder="Description" rows="6">{{ old('description') }}</textarea> @error('description') <span class="invalid-feedback" role="alert"> <strong>{{ $message }}</strong> </span> @enderror </div> </div> <div class="ln_solid"></div> <div class="form-group"> <div class="col-md-12 col-sm-12"> <button type="submit" class="btn btn-success">Submit</button> </div> </div> <br><br> </form> --}} </div> </div> </div> </div> </div> </div> <script> </script> @endsection

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