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编辑当前文件:/home/rejoandoctor/public_html/storage/framework/views/05aa5fab154aa73576bb924009bb090f6a7ac7d2.php

<?php $__env->startSection('title', 'Joruri Doctor | Appointment'); ?>
 
<?php $__env->startSection('content'); ?> 
<div class="main-content">
  <div class="main-content-inner">
      <div class="breadcrumbs ace-save-state" id="breadcrumbs">
         <?php echo $__env->make('layouts.header_menu', \Illuminate\Support\Arr::except(get_defined_vars(), ['__data', '__path']))->render(); ?>
      </div>

<div class="page-content">
        <div class="row">
          
          <form action="<?php echo e(route('store_appointmentby_user')); ?>" method="post">
            <?php echo csrf_field(); ?>
            <div class="row">
              <div class="col-sm-2"></div>
              <div class="col-sm-8">
                <div class="widget-box">
                  <div class="widget-header">
                    <h4 class="widget-title">Doctor Appointment</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">
                      <h1 class="text-danger text-center" style="padding: 10px;">***আপনার সমস্যা ব্যাতীত সকল ফাঁকা ঘর ইংলিশে লিখুন</h1>
                      <hr>
                      <div class="col-sm-6">
                        <span class="label label-lg label-pink arrowed-right">রোগীর তথ্য</span>
                        <input type="text" class="form-group form-control" name="patient_name" value="<?php echo e(Auth::user()->name); ?>" placeholder="রোগীর নাম / Patient Name" required>

<input type="text" class="form-group form-control" name="patient_mobile" value="<?php echo e(Auth::user()->customer->customer_mobile); ?>" placeholder="রোগীর মোবাইল নাম্বার / Patient Mobile Number" maxlength="11" required>
                        
                        <select class="form-group form-control" name="patient_sex" required>
                          <option selected>রোগীর লিঙ্গ নির্বাচন করুন</option>
                          <option value="Male">পুরুষ / Male</option>
                          <option value="Female">মহিলা / Female</option>
                          <option value="Child">শিশু / Child</option>
                          <option value="Infant">বাচ্চা / Infant</option>
                        </select>
                        
                      </div>
                      <div class="col-sm-6">
                        <span class="label label-lg label-pink arrowed-right">প্রাথমিক তথ্য</span>

<input type="text" class="form-group form-control" name="visit_date" id="c_date" value="<?php echo e(date('Y-m-d')); ?>" placeholder="Date" readonly>
                      </div>
                      
                      <textarea class="form-group form-control" id="press_box" placeholder="আপনার সমস্যা গুলো এখানে বাংলায় লিখুন" name="chief_complaints" required></textarea>

<input class="hidden" type="text" name="user_id" value="<?php echo e(Auth::user()->customer_id); ?>">
                      <input class="hidden" type="text" name="doctor_id" value="<?php echo e(Request::segment(3)); ?>">

<div class="form-actions center">
                        <button class="btn btn-sm btn-warning btn-round" type="submit">Appointment</button>
                      </div>
                    </div>
                  </div>
                </div>
              </div>
              <div class="col-sm-2"></div>
            </div>
          </form>            
                
<?php $__env->stopSection(); ?>
<?php echo $__env->make('layouts.user_header', \Illuminate\Support\Arr::except(get_defined_vars(), ['__data', '__path']))->render(); ?><?php /**PATH /home/rejoandoctor/public_html/resources/views/Prescribe/user/appointment_user.blade.php ENDPATH**/ ?>