@extends('layouts.app')

@section('content')
<div class="container-fluid">
    <div class="page-title">
        <div class="row">
            <div class="col-8">
                <h3>Add Doctor</h3>
            </div>
            <div class="col-4">
                <a href="{{ url('home')}}" class="btn btn-secondary pull-right">
                    <i class="fa fa-arrow-left"></i>
                </a>
            </div>
        </div>
    </div>
</div> 

<div class="container default-dashboard"> 
    <div class="row">
        <div class="col-xl-12 box-col-12">
            <div class="card">
                <div class="card-body">

                    <form class="row g-3 needs-validation custom-input"
                          action="{{ route('add.doctor') }}"
                          method="POST"
                          novalidate>
                        @csrf

                        <!-- Doctor Name -->
                        <div class="col-md-6">
                            <label class="form-label">Doctor Name *</label>
                            <input type="text"
                                   name="doctorname"
                                   class="form-control"
                                   value="{{ old('doctorname') }}"
                                   required>
                            @error('doctorname')
                                <div class="invalid-feedback d-block">{{ $message }}</div>
                            @enderror
                        </div>

                        <!-- Mobile Number -->
                        <div class="col-md-6">
    <label class="form-label">Mobile Number *</label>
    <input type="tel"
           name="mobileno"
           class="form-control"
           value="{{ old('mobileno') }}"
           minlength="10"
           maxlength="10"
           pattern="[0-9]{10}"
           required>

    @error('mobileno')
        <div class="invalid-feedback d-block">{{ $message }}</div>
    @enderror
</div>

                        <!-- WhatsApp Number -->
                        <div class="col-md-6">
							<label class="form-label">Is this number on WhatsApp? *</label>
							<select name="whatsappno" class="form-control" required>
								<option value="">-- Select --</option>
								<option value="Yes" {{ old('whatsappno') == 'Yes' ? 'selected' : '' }}>Yes</option>
								<option value="No" {{ old('whatsappno') == 'No' ? 'selected' : '' }}>No</option>
							</select>
							@error('whatsappno')
								<div class="invalid-feedback d-block">{{ $message }}</div>
							@enderror
						</div>

                        <!-- City -->
                        <div class="col-md-6">
                            <label class="form-label">City *</label>
                            <input type="text"
                                   name="city"
                                   class="form-control"
                                   value="{{ old('city') }}"
                                   required>
                            @error('city')
                                <div class="invalid-feedback d-block">{{ $message }}</div>
                            @enderror
                        </div>

                        <!-- MDL Number -->
                        <div class="col-md-6">
                            <label class="form-label">VCS Code *</label>
                            <input type="text"
                                   name="vcscode"
                                   class="form-control"
                                   value="{{ old('vcscode') }}"
                                   required>
                            @error('vcscode')
                                <div class="invalid-feedback d-block">{{ $message }}</div>
                            @enderror
                        </div>

                        <!-- Speciality -->
                        <div class="col-md-6">
                            <label class="form-label">Speciality *</label>
                            <input type="text"
                                   name="speciality"
                                   class="form-control"
                                   value="{{ old('speciality') }}"
                                   required>
                            @error('speciality')
                                <div class="invalid-feedback d-block">{{ $message }}</div>
                            @enderror
                        </div>

                       

                        <div class="col-12">
                            <button class="btn btn-primary" type="submit">
                                Add Doctor
                            </button>
                        </div>

                    </form>

                </div>
            </div>
        </div>
    </div>
</div>
@endsection