snyder/resources/views/app/physicians/get-trained.blade.php

@extends('layouts.physicians')
@section('content')

<div class="bg-light">
  <div class="container pt-3">
    <nav class="mb-0">
      <ol class="breadcrumb">
        <li class="breadcrumb-item"><a href="{{route('index')}}"><u>Home</u></a></li>
        <li class="breadcrumb-item"><a href="{{route('physicians.index')}}"><u>Physicians</u></a></li>
        <li class="breadcrumb-item active" aria-current="page">Get Trained</li>
      </ol>
    </nav>
  </div>
</div>
<div class="container py-5 my-4">
  <div class="row">
    <div class="col-lg-5">
      <h5 class="subtitle">“Schedule a Training” OR “Access Clinical and Staff Training”</h5>
      <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>
      
      <div class="row mt-5">
        <div class="col-sm-6 mb-4">
          <h5 class="header m-0">Our Office</h5>
          <hr class="w-100 my-3">
          <div class="">
            258 Chapman Road, <br>
            Suite 101-A, <br>
            Newark, DE 19702
          </div>
        </div>
        <div class="col-sm-6 mb-4">
          <h5 class="header m-0">Contact</h5>
          <hr class="w-100 my-3">
          <h5 class="mb-2">General questions</h5>
          <div class="mb-4">
            <a class="text-dark" href="mailto:info@snyderhemband.com">info@snyderhemband.com</a> <br>
            <a class="text-dark" href="tel:+1-833-444-8448">+1-833-444-8448</a>
          </div>
          <h5 class="mb-2">For physicians</h5>
          <div class="mb-4">
            <a class="text-dark" href="mailto:phy@snyderhemband.com">phy@snyderhemband.com</a> <br>
            <a class="text-dark" href="tel:+1-833-444-8448">+1-833-444-8448</a>
          </div>
        </div>
      </div>
    </div>
    <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);">
      <h4 class="subtitle">Schedule a Training</h4>
      <p class="mb-4">Fill out the form below to schedule a personalized training session with our team of experts. </p>
      <form class="" action="{{ route('physicians.submit-training-request') }}" method="post">
        @csrf
        <div class="row">
          <div class="col-lg-6 form-group mb-4">
            <input type="text" class="form-control rounded-0 py-3" name="name_first" placeholder="First Name" value="{{ old('name_first') }}" />
            @error('name_first')
            <small class="text-warning">{{$message}}</small>
            @enderror
          </div>
          <div class="col-lg-6 form-group mb-4">
            <input type="text" class="form-control rounded-0 py-3" name="name_last" placeholder="Last Name" value="{{ old('name_last') }}" />
            @error('name_last')
            <small class="text-warning">{{$message}}</small>
            @enderror
          </div>
          <div class="col-lg-12 form-group mb-4">
            <input type="text" class="form-control rounded-0 py-3" name="practice_name" placeholder="Practice Name" value="{{ old('practice_name') }}" />
            @error('practice_name')
            <small class="text-warning">{{$message}}</small>
            @enderror
          </div>
        </div>
        <div class="row">
          <div class="col-lg-6 form-group mb-4">
            <input type="email" class="form-control rounded-0 py-3" name="email" placeholder="Contact Email" value="{{ old('email') }}" />
            @error('email')
            <small class="text-warning">{{$message}}</small>
            @enderror
          </div>
          <div class="col-lg-6 form-group mb-4">
            <input type="text" class="form-control rounded-0 py-3" name="phone" placeholder="Contact Phone Number" value="{{ old('phone') }}" />
            @error('phone')
            <small class="text-warning">{{$message}}</small>
            @enderror
          </div>
        </div>
        
        <div class="form-group mb-4">
          <input type="text" class="form-control rounded-0 py-3" name="zip" placeholder="Zip Code" value="{{ old('zip') }}" />
          @error('zip')
          <small class="text-warning">{{$message}}</small>
          @enderror
        </div>
        <div class="row">
          <div class="col-lg-6 form-group mb-4">
            <select class="form-control rounded-0 py-3" name="training_type">
              <option value="">Training Type</option>
              <option value="Clinical Training">Clinical Training</option>
              <option value="Staff Training">Staff Training</option>
              <option value="Other">Other</option>
            </select>
            @error('training_type')
            <small class="text-warning">{{$message}}</small>
            @enderror
          </div>
          <div class="col-lg-6 form-group mb-4">
          <select class="form-control rounded-0 py-3" name="training_format">
              <option value="">Training Format</option>
              <option value="In-person">In-person</option>
              <option value="Online">Online</option>
            </select>
            @error('training_format')
            <small class="text-warning">{{$message}}</small>
            @enderror
          </div>
        </div>

        <div class="form-group mb-4">
          <textarea name="notes" class="form-control rounded-0" placeholder="Other Notes" rows="6">{{ old('notes') }}</textarea>
          @error('notes')
              <small class="text-warning">{{$message}}</small>
            @enderror
        </div>

        @if($errors->any())
        <div class="alert alert-danger fade show" role="alert">
          There were errors found!
        </div>
        @endif
        @if(session('success'))
        <div class="alert alert-success fade show" role="alert">
          {{session('success')}}
        </div>
        @endif
        <button type="submit" class="btn btn-pry w-100 py-3">Submit</button>
      </form>
    </div>
  </div>
</div>
@endsection