@extends('layouts.website.website')
@section('content')
<section id="main-content">
    <section class="wrapper site-min-height">
        <!-- page start-->
        <section class="panel col-md-6 row">
            <header class="panel-heading">
                Add Appointment            </header>


            <style>
                .panel{
                    background: transparent;
                }

                .payment_label {
                    margin-left: -2%;
                }

            </style>


            <div class="panel-body">
                <div class="adv-table editable-table ">
                                                        </div>
                <form role="form" action="appointment/addNew" class="clearfix row" method="post" enctype="multipart/form-data">
                    <div class="col-md-12 panel">
                        <div class="col-md-3 payment_label">
                            <label for="exampleInputEmail1"> Patient</label>
                        </div>
                        <div class="col-md-9">
                            <select class="form-control m-bot15  pos_select select2-hidden-accessible" id="pos_select" name="patient" value="" tabindex="-1" aria-hidden="true">
                                                                    <option value="" selected="selected"> - </option>
                                                            </select><span class="select2 select2-container select2-container--default" dir="ltr" style="width: 299px;"><span class="selection"><span class="select2-selection select2-selection--single" role="combobox" aria-haspopup="true" aria-expanded="false" tabindex="0" aria-labelledby="select2-pos_select-container"><span class="select2-selection__rendered" id="select2-pos_select-container"><span class="select2-selection__placeholder">Search Patient Name / ID</span></span><span class="select2-selection__arrow" role="presentation"><b role="presentation"></b></span></span></span><span class="dropdown-wrapper" aria-hidden="true"></span></span>
                        </div>
                    </div>
                    <div class="pos_client clearfix" style="display: none;">
                        <div class="col-md-8 payment pad_bot pull-right">
                            <div class="col-md-3 payment_label">
                                <label for="exampleInputEmail1"> Patient Name</label>
                            </div>
                            <div class="col-md-9">
                                <input type="text" class="form-control pay_in" name="p_name" value="" placeholder="">
                            </div>
                        </div>
                        <div class="col-md-8 payment pad_bot pull-right">
                            <div class="col-md-3 payment_label">
                                <label for="exampleInputEmail1"> Patient Email</label>
                            </div>
                            <div class="col-md-9">
                                <input type="text" class="form-control pay_in" name="p_email" value="" placeholder="">
                            </div>
                        </div>
                        <div class="col-md-8 payment pad_bot pull-right">
                            <div class="col-md-3 payment_label">
                                <label for="exampleInputEmail1"> Patient Phone</label>
                            </div>
                            <div class="col-md-9">
                                <input type="text" class="form-control pay_in" name="p_phone" value="" placeholder="">
                            </div>
                        </div>
                        <div class="col-md-8 payment pad_bot pull-right">
                            <div class="col-md-3 payment_label">
                                <label for="exampleInputEmail1"> Patient Age</label>
                            </div>
                            <div class="col-md-9">
                                <input type="text" class="form-control pay_in" name="p_age" value="" placeholder="">
                            </div>
                        </div>
                        <div class="col-md-8 payment pad_bot pull-right">
                            <div class="col-md-3 payment_label">
                                <label for="exampleInputEmail1"> Patient Gender</label>
                            </div>
                            <div class="col-md-9">
                                <select class="form-control m-bot15" name="p_gender" value="">

                                    <option value="Male"> Male </option>
                                    <option value="Female"> Female </option>
                                    <option value="Others"> Others </option>
                                </select>
                            </div>
                        </div>
                    </div>

                    <div class="col-md-12 panel">
                        <div class="col-md-3 payment_label">
                            <label for="exampleInputEmail1">  Doctor</label>
                        </div>
                        <div class="col-md-9">
                            <select class="form-control m-bot15 select2-hidden-accessible" id="adoctors" name="doctor" value="" tabindex="-1" aria-hidden="true">
                                                                    <option value="" selected="selected"> - </option>
                                                            </select><span class="select2 select2-container select2-container--default" dir="ltr" style="width: 299px;"><span class="selection"><span class="select2-selection select2-selection--single" role="combobox" aria-haspopup="true" aria-expanded="false" tabindex="0" aria-labelledby="select2-adoctors-container"><span class="select2-selection__rendered" id="select2-adoctors-container"><span class="select2-selection__placeholder">Search Doctor Name / ID</span></span><span class="select2-selection__arrow" role="presentation"><b role="presentation"></b></span></span></span><span class="dropdown-wrapper" aria-hidden="true"></span></span>
                        </div>
                    </div>


                    <div class="col-md-12 panel">
                        <div class="col-md-3 payment_label">
                            <label for="exampleInputEmail1"> Date</label>
                        </div>
                        <div class="col-md-9">
                            <input type="text" class="form-control" id="date" readonly="" name="date" value="" placeholder="">
                        </div>
                    </div>

                    <div class="col-md-12 panel">
                        <div class="col-md-3 payment_label">
                            <label class="">Available Slots</label>
                        </div>
                        <div class="col-md-9">
                            <select class="form-control m-bot15" name="time_slot" id="aslots" value="">

                            <option value="Not Selected">No Further Time Slots</option></select>
                        </div>
                    </div>


                    <div class="col-md-12 panel">
                        <div class="col-md-3 payment_label">
                            <label for="exampleInputEmail1"> Remarks</label>
                        </div>
                        <div class="col-md-9">
                            <input type="text" class="form-control" name="remarks" id="exampleInputEmail1" value="" placeholder="">
                        </div>
                    </div>


                    <div class="col-md-12 panel">
                        <div class="col-md-3 payment_label">
                            <label for="exampleInputEmail1"> Appointment Status</label>
                        </div>
                        <div class="col-md-9">
                            <select class="form-control m-bot15" name="status" value="">
                                <option value="Pending Confirmation"> Pending Confirmation </option>
                                <option value="Confirmed"> Confirmed </option>
                                <option value="Treated"> Treated </option>
                                <option value="cancelled"> Cancelled </option>
                            </select>
                        </div>
                    </div>

                    <!--     <div class="col-md-12 panel">
                         <div class="col-md-3 payment_label">
                         </div>
                         <div class="col-md-9">
                             <input type="checkbox" name="sms" value="sms"> Send SMS<br>
                         </div>
                     </div>
                    -->





                    <input type="hidden" name="id" id="appointment_id" value="">

                    <div class="col-md-12 panel">
                        <div class="col-md-3 payment_label">
                        </div>
                        <div class="col-md-9">
                            <button type="submit" name="submit" class="btn btn-info pull-right"> Submit</button>
                        </div>
                    </div>


                </form>
            </div>

        </section>
        <!-- page end-->
    </section>
</section>
@endsection
