<?php $page = 'paitent-details'; ?>
@extends('layout.mainlayout')
@section('content')
<!-- Page Content -->
<div class="doctor-content">
    <div class="container">

        <!-- Patient -->
        <div class="row">
            <div class="col-md-12">
                <div class="back-link">
                    <a href="{{url('booking')}}"><i class="fa-solid fa-arrow-left-long"></i> Back</a>
                </div>
            </div>
        </div>
        <div class="row">
            <div class="col-lg-8 col-md-12">
                <div class="paitent-header">
                    <h4 class="paitent-title">Patient Details</h4>
                </div>
                <div class="paitent-appointment">
                    <form action="{{url('consultation')}}">
                        <div class="forms-block">
                            <label class="form-group-title">Appointment for</label>
                            <label class="custom_radio me-4">
                                <input type="radio" name="appointment" checked>
                                <span class="checkmark"></span> My Self
                            </label>
                            <label class="custom_radio">
                                <input type="radio" name="appointment">
                                <span class="checkmark"></span> Dependent
                            </label>
                        </div>
                        <div class="forms-block">
                            <div class="form-group-flex">
                                <label class="form-group-title">Choose Dependent</label>
                                <a href="javascript:void(0);" class="btn">
                                    <i class="feather-plus"></i> Add
                                </a>
                            </div>
                            <div class="paitent-dependent-select">
                                <select class="select">
                                    <option>Select</option>
                                    <option>Dependent 01</option>
                                    <option>Dependent 02</option>
                                    <option>Dependent 03</option>
                                    <option>Dependent 04</option>
                                </select>
                            </div>
                        </div>
                        <div class="forms-block">
                            <label class="form-group-title">Do you have insurance?</label>
                            <label class="custom_radio me-4">
                                <input type="radio" name="insurance">
                                <span class="checkmark"></span> Yes
                            </label>
                            <label class="custom_radio">
                                <input type="radio" name="insurance" checked>
                                <span class="checkmark"></span> No
                            </label>
                        </div>
                        <div class="forms-block">
                            <label class="form-group-title">Reason</label>
                            <textarea class="form-control" placeholder="Enter Your Reason"></textarea>
                            <p class="characters-text">400 Characters</p>
                        </div>
                        <div class="forms-block">
                            <label class="form-group-title d-flex align-items-center">
                                <i class="fa fa-paperclip me-2"></i> Attachment
                            </label>
                            <div class="attachment-box">
                                <div class="attachment-img">
                                    <div class="attachment-icon">
                                        <i class="feather-image"></i>
                                    </div>
                                    <div class="attachment-content">
                                        <p>Skin Allergy Image</p>
                                        <span>12.30 mb</span>
                                    </div>
                                </div>
                                <div class="attachment-close">
                                    <a href="javascript:void(0);"><i class="feather-x"></i></a>
                                </div>
                            </div>
                        </div>
                        <div class="forms-block">
                            <label class="form-group-title">Symtoms <span>(Optional)</span></label>
                            <input type="text" class="form-control" placeholder="Skin Allergy">
                        </div>
                        <div class="forms-block mb-0">
                            <div class="booking-btn">
                                <button type="submit" class="btn btn-primary prime-btn justify-content-center align-items-center">
                                    Next <i class="feather-arrow-right-circle"></i>
                                </button>
                            </div>
                        </div>
                    </form>
                </div>
            </div>
            <div class="col-lg-4 col-md-12">
                <div class="booking-header">
                    <h4 class="booking-title">Booking Summary</h4>
                </div>
                <div class="card booking-card">
                    <div class="card-body booking-card-body">
                        <div class="booking-doctor-details">
                            <div class="booking-doctor-left">
                                <div class="booking-doctor-img">
                                    <a href="{{url('doctor-profile')}}">
                                        <img src="{{URL::asset('/assets/img/doctors/doctor-02.jpg')}}" alt="John Doe">
                                    </a>
                                </div>
                                <div class="booking-doctor-info">
                                    <h4><a href="{{url('doctor-profile')}}">Dr. John Doe</a></h4>
                                    <p>MBBS, Dentist</p>
                                </div>
                            </div>
                            <div class="booking-doctor-right">
                                <p>
                                    <i class="fas fa-circle-check"></i>
                                    <a href="{{url('doctor-profile-settings')}}">Edit</a>
                                </p>
                            </div>
                        </div>
                    </div>
                </div>
                <div class="card booking-card">
                    <div class="card-body booking-card-body booking-list-body">
                        <div class="booking-list">
                            <div class="booking-date-list">
                                <ul>
                                    <li>Booking Date: <span>Sun, 30 Aug 2023</span></li>
                                    <li>Booking Time: <span>10.00AM to 11:00AM</span></li>
                                </ul>
                            </div>
                            <div class="booking-doctor-right">
                                <p>
                                    <a href="{{url('booking')}}">Edit</a>
                                </p>
                            </div>
                        </div>
                    </div>
                </div>
                <div class="card booking-card">
                    <div class="card-body booking-card-body">
                        <div class="booking-doctor-details">
                            <div class="booking-device">
                                <div class="booking-device-img">
                                    <img src="{{URL::asset('/assets/img/icons/device-message.svg')}}" alt="device-message-image">
                                </div>
                                <div class="booking-doctor-info">
                                    <h3>We can help you</h3>
                                    <p class="device-text">Call us +1 888-888-8888 (or) chat with our customer support team.</p>
                                    <a href="{{url('chat')}}" class="btn">Chat With Us</a>
                                </div>
                            </div>
                        </div>
                    </div>
                </div>
                <div class="card booking-card mb-0">
                    <div class="card-body booking-card-body">
                        <div class="booking-doctor-details">
                            <div class="booking-device">
                                <div class="booking-device-img">
                                    <img src="{{URL::asset('/assets/img/icons/smart-phone.svg')}}" alt="smart-phone">
                                </div>
                                <div class="booking-doctor-info">
                                    <h3>Get the App</h3>
                                    <p class="device-text">Download our app for better experience and for more feature</p>
                                    <div class="app-images">
                                        <a href="javascript:void(0);">
                                            <img src="{{URL::asset('/assets/img/google-img.svg')}}" alt="google-image">
                                        </a>
                                        <a href="javascript:void(0);">
                                            <img src="{{URL::asset('/assets/img/app-img.svg')}}" alt="app-image">
                                        </a>
                                    </div>
                                </div>
                            </div>
                        </div>
                    </div>
                </div>
            </div>
        </div>
        <!-- /Patient -->

    </div>
</div>		
<!-- /Page Content -->

<!-- Cursor -->
<div class="mouse-cursor cursor-outer"></div>
<div class="mouse-cursor cursor-inner"></div>
<!-- /Cursor -->	


@endsection