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@extends('layouts.app') @section('title') Invitation Form @endsection @section('content') <style> .error { color: red; font-size: 16px; } </style> <!-- SIGNUP FORM SECTION BEGIN --> <section class="signup-form-sec"> <div class="container"> <form method="POST" action="{{ route('invitation.accepted') }}" id="register"> @csrf <h4 class="signup-portal">Invitation from <strong>{{ $practice->name }}</strong></h4> @include('layouts.flash-message') <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">First Name</label> <input type="text" name="first_name" value="{{ old('first_name') }}" class="form-control " required placeholder="Enter First Name"> @error('first_name') <span class="invalid-feedback" role="alert"> <strong>{{ $message }}</strong> </span> @enderror </div> <input type="hidden" name="token" value="{{ $invitationForm->token }}"> <div class="field-cls"> <label class="label-text">Last Name</label> <input type="text" name="last_name" value="{{ old('last_name') }}" class="form-control " required placeholder="Enter Last Name"> @error('last_name') <span class="invalid-feedback" role="alert"> <strong>{{ $message }}</strong> </span> @enderror </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">Email</label> <input type="email" name="email" class="form-control " placeholder="Enter Email" pattern="\b[A-Za-z0-9._%+-]+@[A-Za-z0-9.-]+\.[A-Za-z]{2,4}\b" value="{{ $invitationForm->email }}" readonly> @error('email') <span class="invalid-feedback" role="alert"> <strong>{{ $message }}</strong> </span> @enderror </div> <div class="field-cls"> <label class="label-text">Phone</label> <input type="number" name="phone" value="{{ old('phone') }}" class="form-control " placeholder="Enter Phone no" required> @error('phone') <span class="invalid-feedback" role="alert"> <strong>{{ $message }}</strong> </span> @enderror </div> </div> </div> </div> <div class="row"> <div class="col-md-12 col-sm-12 col-12"> <div class="main-flex-cls"> <div class="field-cls"> <label class="label-text">Job Title</label> <select class="form-control @error('job_id') is-invalid @enderror" name="job_id" id="job_id" required disabled> @foreach ($jobTitles as $jobTitle) <option {{ $invitationForm->job_title == $jobTitle->id ? 'selected' : '' }} value="{{ $jobTitle->id }}">{{ $jobTitle->title }}</option> @endforeach </select> @error('job_id') <span class="invalid-feedback" role="alert"> <strong>{{ $message }}</strong> </span> @enderror </div> </div> </div> </div> {{-- @if ($invitationForm->job_title == 2) <div class="row dentistDiv"> <div class="col-md-12 col-sm-12 col-12"> <div class="main-flex-cls"> <div class="field-cls"> <label class="label-text">GDC No</label> <input type="text" name="gdc_no" value="{{ old('gdc_no') }}" class="form-control " placeholder="GDC No"> @error('gdc_no') <span class="invalid-feedback" role="alert"> <strong>{{ $message }}</strong> </span> @enderror </div> <div class="field-cls"> <label class="label-text">Treatments</label> <select class="form-control " name="treatments[]" id="treatments" multiple> <option value="">Select Treatments</option> </select> @error('treatments') <span class="invalid-feedback" role="alert"> <strong>{{ $message }}</strong> </span> @enderror </div> </div> </div> </div> <div class="row dentistDiv"> <div class="col-md-12 col-sm-12 col-12"> <div class="main-flex-cls"> <div class="field-cls"> <label class="label-text">Desccription</label> <textarea name="description" id="description" rows="8" class="form-control " placeholder="Description">{{ old('description') }}</textarea> @error('description') <span class="invalid-feedback" role="alert"> <strong>{{ $message }}</strong> </span> @enderror </div> </div> </div> </div> @endif --}} <div class="row"> <div class="col-md-12 col-sm-12 col-12"> <div class="main-flex-cls"> <div class="field-cls position-relative"> <label class="label-text">Password</label> <input type="password" name="password" id="password" minlength="8" maxlength="20" value="{{ old('password') }}" class="form-control -pass-attr" placeholder="******" required pattern="^.(?=.{3,})(?=.[a-zA-Z])(?=.[0-9])(?=.[\d\x])(?=.[!$#%]).$"> <span id="showPass"> <i class="fa fa-eye eye-icon-register " onclick="viewpwd(this)" data-id="password" aria-hidden="true"></i> </span> @error('password') <span class="invalid-feedback" role="alert"> <strong>{{ $message }}</strong> </span> @enderror </div> <div class="field-cls position-relative"> <label class="label-text">Confirm Password</label> <input type="password" name="password_confirmation" id="password_confirmation" minlength="8" maxlength="20" value="{{ old('password_confirmation') }}" class="form-control -pass-attr" placeholder="******" required pattern="^.(?=.{3,})(?=.[a-zA-Z])(?=.[0-9])(?=.[\d\x])(?=.[!$#%]).$"> <span id="showPass"> <i class="fa fa-eye eye-icon-register " data-id="password_confirmation" onclick="viewpwd(this)" aria-hidden="true"></i> </span> @error('password_confirmation') <span class="invalid-feedback" role="alert"><strong>{{ $message }}</strong></span> @enderror </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">Address</label> <input type="text" name="address" value="{{ old('address') }}" class="form-control " placeholder="Street address" required> @error('address') <span class="invalid-feedback" role="alert"> <strong>{{ $message }}</strong> </span> @enderror </div> <div class="field-cls"> <label class="label-text">&nbsp</label> <input type="text" 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" name="city" value="{{ old('city') }}" class="form-control" required placeholder="City"> @error('city') <span class="invalid-feedback" role="alert"> <strong>{{ $message }}</strong> </span> @enderror </div> <div class="field-cls"> <input type="text" name="zip_code" value="{{ old('zip_code') }}" class="form-control" placeholder="Postcode"> </div> <div class="field-cls"> <input type="text" name="country" value="{{ old('country') }}" class="form-control" placeholder="Country"> @error('country') <span class="invalid-feedback" role="alert"> <strong>{{ $message }}</strong> </span> @enderror </div> </div> </div> </div> <div class="signup-btn"> <button type="submit" class="btn btn-primary">Register</button> </div> </form> <div class="register-link"> <p class="register-text text-dark">If you already have an account. Please <a href="/login" class="register-text-link text-primary">Login</a></p> </div> </div> </section> <!-- SIGNUP FORM SECTION END --> @endsection @section('script') <script src="https://cdn.jsdelivr.net/jquery.validation/1.16.0/jquery.validate.min.js"></script> <script> function viewpwd(identifier) { $(identifier).toggleClass("fa-eye fa-eye-slash"); var id = $(identifier).data('id'); var input = $("#" + id) if (input.attr("type") == "password") { input.attr("type", "text"); } else { input.attr("type", "password"); } } jQuery.validator.addMethod("hasUppercase", function(value, element) { if (this.optional(element)) { return true; } return /[A-Z]/.test(value); }, "Password must have one uppercase letter"); jQuery.validator.addMethod("hasSpecial", function(value, element) { if (this.optional(element)) { return true; } return /[#?!@$%^&*-]/.test(value); }, "Password must have one Special Character"); jQuery.validator.addMethod("hasNumber", function(value, element) { if (this.optional(element)) { return true; } return /[0-9]/.test(value); }, "Password must have one number"); jQuery.validator.addMethod("hasLowercase", function(value, element) { if (this.optional(element)) { return true; } return /[a-z]/.test(value); }, "Password must have one lowercase letter"); $(document).ready(function() { @if ($invitationForm->job_title == 2) $("#register").validate({ rules: { first_name: { required: true }, last_name: { required: true }, email: { required: true, email: true }, phone: { required: true, number: true }, password: { required: true, hasUppercase: true, hasLowercase: true, hasNumber: true, hasSpecial: true, minlength: 8, maxlength: 20, }, password_confirmation: { required: true, equalTo: "#password" }, practice_id: { required: true, }, job_id: { required: true, }, address: { required: true }, city: { required: true }, country: { required: true }, }, messages: { first_name: { required: "First name is required" }, last_name: { required: "Last name is required" }, email: { required: "Email is required", email: "Email must be a valid email address" }, phone: { required: "Phone number is required" }, password: { required: "Password is required", minlength: "Password must be at least 8 characters", maxlength: "Password max 20 characters" }, password_confirmation: { required: "Confirm password is required", equalTo: "Password and confirm password should same" }, practice_id: { required: "Please select the Practice", }, job_id: { required: "Please select the Job Title", }, address: { required: "Address is required", }, city: { required: "City is required", }, country: { required: "Country is required", }, } }); @else $(".dentistDiv").hide(); $("#register").validate({ rules: { first_name: { required: true }, last_name: { required: true }, email: { required: true, email: true }, phone: { required: true, number: true }, password: { required: true, hasUppercase: true, hasLowercase: true, hasNumber: true, hasSpecial: true, minlength: 8, maxlength: 20, }, password_confirmation: { required: true, equalTo: "#password" }, practice_id: { required: true, }, job_id: { required: true, }, address: { required: true }, city: { required: true }, country: { required: true } }, messages: { first_name: { required: "First name is required" }, last_name: { required: "Last name is required" }, email: { required: "Email is required", email: "Email must be a valid email address" }, phone: { required: "Phone number is required" }, password: { required: "Password is required", minlength: "Password must be at least 8 characters", maxlength: "Password max 20 characters" }, password_confirmation: { required: "Confirm password is required", equalTo: "Password and confirm password should same" }, practice_id: { required: "Please select the Practice", }, job_id: { required: "Please select the Job Title", }, address: { required: "Address is required", }, city: { required: "City is required", }, country: { required: "Country is required", } } }); @endif $.ajax({ url: "/practice/" + {{ $invitationForm->practice_id }} + "/specialities", type: "GET", dataType: 'json', success: function(result) { $("#treatments").html(''); $.each(result, function(key, value) { $("#treatments").append('<option value="' + value.id + '">' + value.title + '</option>'); }); $("#treatments").select2({ allowClear: true, placeholder: "Select Treatments", multiple: true }).trigger("change"); } }); $("#treatments").select2({ allowClear: true, placeholder: "Select Treatments", multiple: true }).trigger("change"); }); </script> @endsection

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