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@@ -2,32 +2,138 @@
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@section('content')
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<div class="bg-light">
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- <div class="container pt-3">
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- <nav class="mb-0">
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- <ol class="breadcrumb">
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- <li class="breadcrumb-item"><a href="{{route('index')}}"><u>Home</u></a></li>
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- <li class="breadcrumb-item"><a href="{{route('physicians.index')}}"><u>Physicians</u></a></li>
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- <li class="breadcrumb-item active" aria-current="page">Get Trained</li>
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- </ol>
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- </nav>
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- </div>
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-</div>
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-<div class="bg-grey py-5">
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- <div class="container py-lg-4">
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- <div class="row justify-content-center">
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- <div class="col-lg-7 text-center">
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- <h5 class="subtitle">Get Trained</h5>
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- <p>Lorem ipsum dolor sit amet consectetur, adipisicing elit. Dolore repellat dolorem accusantium similique quae temporibus molestias cupiditate. Adipisci deleniti magni quisquam quibusdam asperiores repudiandae, cumque, dolore maxime nam cum velit.</p>
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- </div>
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- </div>
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+ <div class="container pt-3">
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+ <nav class="mb-0">
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+ <ol class="breadcrumb">
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+ <li class="breadcrumb-item"><a href="{{route('index')}}"><u>Home</u></a></li>
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+ <li class="breadcrumb-item"><a href="{{route('physicians.index')}}"><u>Physicians</u></a></li>
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+ <li class="breadcrumb-item active" aria-current="page">Get Trained</li>
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+ </ol>
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+ </nav>
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</div>
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</div>
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-<div class="container py-5">
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+<div class="container py-5 my-4">
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<div class="row">
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- <div class="col-md-12">
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+ <div class="col-lg-5">
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+ <h5 class="subtitle">“Schedule a Training” OR “Access Clinical and Staff Training”</h5>
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+ <p>We’re excited that your practice is interested in offering the Snyder HemBand system to your patients. To provide the best in patient care, we have a number of training modules for physicians, clinical staff, and office staff available to support our practice partners. Our in-person and online module options have been created with the help of leading gastroenterologists.</p>
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+
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+ <div class="row mt-5">
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+ <div class="col-sm-6 mb-4">
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+ <h5 class="header m-0">Our Office</h5>
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+ <hr class="w-100 my-3">
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+ <div class="">
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+ 258 Chapman Road, <br>
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+ Suite 101-A, <br>
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+ Newark, DE 19702
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+ </div>
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+ </div>
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+ <div class="col-sm-6 mb-4">
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+ <h5 class="header m-0">Contact</h5>
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+ <hr class="w-100 my-3">
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+ <h5 class="mb-2">General questions</h5>
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+ <div class="mb-4">
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+ <a class="text-dark" href="mailto:info@snyderhemband.com">info@snyderhemband.com</a> <br>
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+ <a class="text-dark" href="tel:+1-833-444-8448">+1-833-444-8448</a>
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+ </div>
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+ <h5 class="mb-2">For physicians</h5>
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+ <div class="mb-4">
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+ <a class="text-dark" href="mailto:phy@snyderhemband.com">phy@snyderhemband.com</a> <br>
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+ <a class="text-dark" href="tel:+1-833-444-8448">+1-833-444-8448</a>
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+ </div>
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+ </div>
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+ </div>
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+ </div>
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+ <div class="col-lg-6 bg-grey p-lg-5 p-4 mb-4 offset-lg-1" style="border-bottom:7px solid var(--pry-color);">
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+ <h4 class="subtitle">Schedule a Training</h4>
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+ <p class="mb-4">Fill out the form below to schedule a personalized training session with our team of experts. </p>
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+ <form class="" action="{{ route('physicians.submit-training-request') }}" method="post">
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+ @csrf
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+ <div class="row">
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+ <div class="col-lg-6 form-group mb-4">
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+ <input type="text" class="form-control rounded-0 py-3" name="name_first" placeholder="First Name" value="{{ old('name_first') }}" />
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+ @error('name_first')
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+ <small class="text-warning">{{$message}}</small>
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+ @enderror
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+ </div>
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+ <div class="col-lg-6 form-group mb-4">
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+ <input type="text" class="form-control rounded-0 py-3" name="name_last" placeholder="Last Name" value="{{ old('name_last') }}" />
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+ @error('name_last')
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+ <small class="text-warning">{{$message}}</small>
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+ @enderror
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+ </div>
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+ <div class="col-lg-12 form-group mb-4">
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+ <input type="text" class="form-control rounded-0 py-3" name="practice_name" placeholder="Practice Name" value="{{ old('practice_name') }}" />
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+ @error('practice_name')
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+ <small class="text-warning">{{$message}}</small>
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+ @enderror
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+ </div>
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+ </div>
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+ <div class="row">
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+ <div class="col-lg-6 form-group mb-4">
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+ <input type="email" class="form-control rounded-0 py-3" name="email" placeholder="Contact Email" value="{{ old('email') }}" />
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+ @error('email')
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+ <small class="text-warning">{{$message}}</small>
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+ @enderror
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+ </div>
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+ <div class="col-lg-6 form-group mb-4">
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+ <input type="text" class="form-control rounded-0 py-3" name="phone" placeholder="Contact Phone Number" value="{{ old('phone') }}" />
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+ @error('phone')
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+ <small class="text-warning">{{$message}}</small>
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+ @enderror
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+ </div>
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+ </div>
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+ <div class="form-group mb-4">
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+ <input type="text" class="form-control rounded-0 py-3" name="zip" placeholder="Zip Code" value="{{ old('zip') }}" />
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+ @error('zip')
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+ <small class="text-warning">{{$message}}</small>
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+ @enderror
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+ </div>
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+ <div class="row">
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+ <div class="col-lg-6 form-group mb-4">
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+ <select class="form-control rounded-0 py-3" name="training_type">
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+ <option value="">Training Type</option>
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+ <option value="Clinical Training">Clinical Training</option>
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+ <option value="Staff Training">Staff Training</option>
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+ <option value="Other">Other</option>
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+ </select>
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+ @error('training_type')
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+ <small class="text-warning">{{$message}}</small>
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+ @enderror
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+ </div>
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+ <div class="col-lg-6 form-group mb-4">
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+ <select class="form-control rounded-0 py-3" name="training_format">
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+ <option value="">Training Format</option>
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+ <option value="In-person">In-person</option>
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+ <option value="Online">Online</option>
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+ </select>
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+ @error('training_format')
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+ <small class="text-warning">{{$message}}</small>
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+ @enderror
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+ </div>
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+ </div>
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+
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+ <div class="form-group mb-4">
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+ <textarea name="notes" class="form-control rounded-0" placeholder="Other Notes" rows="6">{{ old('notes') }}</textarea>
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+ @error('notes')
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+ <small class="text-warning">{{$message}}</small>
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+ @enderror
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+ </div>
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+
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+ @if($errors->any())
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+ <div class="alert alert-danger fade show" role="alert">
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+ There were errors found!
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+ </div>
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+ @endif
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+ @if(session('success'))
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+ <div class="alert alert-success fade show" role="alert">
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+ {{session('success')}}
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+ </div>
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+ @endif
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+ <button type="submit" class="btn btn-pry w-100 py-3">Submit</button>
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+ </form>
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</div>
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</div>
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</div>
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-
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@endsection
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