Server : Apache System : Linux server2.corals.io 4.18.0-348.2.1.el8_5.x86_64 #1 SMP Mon Nov 15 09:17:08 EST 2021 x86_64 User : corals ( 1002) PHP Version : 7.4.33 Disable Function : exec,passthru,shell_exec,system Directory : /home/corals/clinic.corals.io/storage/framework/views/ |
<?php $__env->startSection('title'); ?>
<?php echo e(__('messages.register')); ?>
<?php $__env->stopSection(); ?>
<?php $__env->startSection('content'); ?>
<div class="d-flex flex-center flex-column flex-column-fluid p-10 pb-lg-20">
<a href="<?php echo e(route('medical')); ?>" class="mb-5">
<img alt="Logo" src="<?php echo e(asset(getAppLogo())); ?>" class="h-70px logo">
</a>
<div class="w-lg-600px">
<?php echo $__env->make('layouts.errors', \Illuminate\Support\Arr::except(get_defined_vars(), ['__data', '__path']))->render(); ?>
<div class=" bg-white rounded shadow-sm p-10 p-lg-15 mx-auto">
<form class="form w-100" method="POST" action="<?php echo e(route('register')); ?>">
<?php echo csrf_field(); ?>
<div class="mb-10 text-center">
<h1 class="text-dark mb-3"><?php echo e(__('messages.web.patient_registration')); ?></h1>
<div class="text-gray-400 fw-bold fs-4 d-sm-block d-grid"><?php echo e(__('messages.web.already_have_an_account')); ?>?
<a href="<?php echo e(route('login')); ?>"
class="link-primary fw-bolder"><?php echo e(__('messages.web.sign_in_here')); ?></a></div>
</div>
<div class="row fv-row mb-7">
<!-- Name -->
<div class="col-xl-6 mb-7 mb-xl-0">
<label class="form-label fw-bolder text-dark fs-6 required"
for="name"><?php echo e(__('messages.patient.first_name')); ?>:</label>
<input class="form-control form-control-lg form-control-solid" id="name"
placeholder="First Name"
value="<?php echo e(old('first_name')); ?>" type="text" name="first_name" autocomplete="off"
required
autofocus/>
<div class="invalid-feedback">
<?php echo e($errors->first('first_name')); ?>
</div>
</div>
<!-- Last Name -->
<div class="col-xl-6">
<label class="form-label fw-bolder text-dark fs-6 required"
for="last_name"><?php echo e(__('messages.patient.last_name')); ?>:</label>
<input class="form-control form-control-lg form-control-solid" type="text"
placeholder="Last Name"
value="<?php echo e(old('last_name')); ?>" name="last_name" autocomplete="off" required
/>
<div class="invalid-feedback">
<?php echo e($errors->first('last_name')); ?>
</div>
</div>
</div>
<!-- Email Address -->
<div class="fv-row mb-7">
<label class="form-label fw-bolder text-dark fs-6 required"
for="email"><?php echo e(__('messages.patient.email')); ?>:</label>
<input class="form-control form-control-lg form-control-solid" id="email"
value="<?php echo e(old('email')); ?>" placeholder="Email"
type="email" name="email" required autocomplete="off"/>
<div class="invalid-feedback">
<?php echo e($errors->first('email')); ?>
</div>
</div>
<!-- Password -->
<div class="mb-10 fv-row" data-kt-password-meter="true">
<div class="mb-1">
<label class="form-label fw-bolder text-dark fs-6 required"
for="password"><?php echo e(__('messages.patient.password')); ?>:</label>
<div class="position-relative mb-3">
<input class="form-control form-control-lg form-control-solid" id="password"
type="password" required
placeholder="Password" name="password" autocomplete="new-password"/>
<div class="invalid-feedback">
<?php echo e($errors->first('password')); ?>
</div>
<span class="btn btn-sm btn-icon position-absolute translate-middle top-50 end-0 me-n2"
data-kt-password-meter-control="visibility">
<i class="bi bi-eye-slash fs-2"></i>
<i class="bi bi-eye fs-2 d-none"></i>
</span>
<div class="d-flex align-items-center mb-3"
data-kt-password-meter-control="highlight"></div>
</div>
</div>
</div>
<div class="mb-10 fv-row" data-kt-password-meter="true">
<div class="mb-1">
<label class="form-label fw-bolder text-dark fs-6 required" for="password">
<?php echo e(__('messages.patient.confirm_password')); ?>:</label>
<div class="position-relative mb-3">
<input class="form-control form-control-lg form-control-solid" type="password" required
placeholder="Confirm Password"
id="password_confirmation" name="password_confirmation" autocomplete="off"/>
<div class="invalid-feedback">
<?php echo e($errors->first('password_confirmation')); ?>
</div>
<span class="btn btn-sm btn-icon position-absolute translate-middle top-50 end-0 me-n2"
data-kt-password-meter-control="visibility">
<i class="bi bi-eye-slash fs-2"></i>
<i class="bi bi-eye fs-2 d-none"></i>
</span>
<div class="d-flex align-items-center mb-3"
data-kt-password-meter-control="highlight"></div>
</div>
</div>
</div>
<div class="fv-row mb-10">
<label class="form-check form-check-custom form-check-solid form-check-inline">
<input class="form-check-input" type="checkbox" name="toc" value="1" required/>
<span class="form-check-label fw-bold text-gray-700 fs-6"><?php echo e(__('messages.web.i_agree')); ?>
<a href="<?php echo e(route('terms.conditions')); ?>"
class="ms-1 link-primary"><?php echo e(__('messages.web.terms_and_conditions')); ?></a>.</span>
</label>
</div>
<div class="text-center">
<button type="submit" class="btn btn-lg btn-primary">
<span class="indicator-label"> <?php echo e(__('messages.register')); ?></span>
<span class="indicator-progress"><?php echo e(__('messages.common.please_wait')); ?>
<span class="spinner-border spinner-border-sm align-middle ms-2"></span></span>
</button>
</div>
</form>
</div>
</div>
</div>
<!--end::Main-->
<?php $__env->stopSection(); ?>
<?php echo $__env->make('layouts.auth', \Illuminate\Support\Arr::except(get_defined_vars(), ['__data', '__path']))->render(); ?><?php /**PATH /home/corals/clinic.corals.io/resources/views/auth/register.blade.php ENDPATH**/ ?>