{{ __('messages.web_appointment.make_an_appointment') }}
{{ Form::radio('patient_type', '1', true, ['class' => 'form-check-input new-patient-radio','id'=>'newPatient1']) }}
{{ Form::radio('patient_type', '2', false, ['class' => 'form-check-input old-patient-radio','id'=>'oldPatient1']) }}
{{ Form::text('patient_name', null, ['class' => 'form-control', 'id' => 'patientName', 'autocomplete' => 'off', 'required', 'disabled']) }}
{{ Form::hidden('patient_id',null,['id'=>'patient']) }}
{{ Form::text('first_name', null, ['class' => 'form-control ','placeholder'=>Lang::get('messages.web_appointment.enter_your_first_name'),'autocomplete' => 'off','required','id'=>'frontAppointmentFirstName']) }}
{{ Form::text('last_name', null, ['class' => 'form-control','placeholder'=>Lang::get('messages.web_appointment.enter_your_last_name'),'autocomplete' => 'off','required','id'=>'frontAppointmentLastName']) }}
{{ Form::email('email', null, ['class' => 'form-control old-patient-email','placeholder'=>Lang::get('messages.web_contact.enter_your_email'),'autocomplete' => 'off','required']) }}
{{ Form::password('password', ['class' => 'form-control','placeholder'=>Lang::get('messages.web_appointment.enter_your_password'),'required','min' => '6','max' => '10','id'=>'frontAppointmentPassword']) }}
{{ Form::password('password_confirmation', ['class' => 'form-control','placeholder'=>Lang::get('messages.web_appointment.enter_confirm_password'),'required','min' => '6','max' => '10','id'=>'frontAppointmentConfirmPassword']) }}
{{ Form::select('department_id',$departments, null, ['id' => 'frontAppointmentDepartmentId', 'placeholder'=>Lang::get('messages.web_appointment.select_department')]) }}
{{ Form::hidden('doctors', isset(session()->get('data')['doctorId']) ? session()->get('data')['doctorId'] : null, ['id' => 'doctor']) }}
{{ Form::hidden('apdate', isset(session()->get('data')['appointmentDate']) ? session()->get('data')['appointmentDate'] : null, ['id' => 'appointmentDate']) }}
{{--
--}}
{{--
--}}
{{ Form::select('doctor_id',$doctors, isset(session()->get('data')['doctorId']) ? session()->get('data')['doctorId'] : null, ['class' => 'selectized', 'autocomplete' => 'off', 'id' => 'frontAppointmentDoctorId', 'placeholder'=>Lang::get('messages.web_appointment.select_doctor')]) }}
{{ Form::text('opd_date', null, ['class' => 'form-control ', 'autocomplete' => 'off', 'id' => 'frontAppointmentOPDDate','required']) }}
{{ Form::textarea('problem', null, ['class' => 'form-control form-textarea','placeholder'=>Lang::get('messages.web_appointment.enter_description'),'autocomplete' => 'off', 'rows' => 4]) }}