snyder/resources/views/app/physicians/practice-support/training.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"><a href="{{route('physicians.practice-support')}}"><u>Practice Support</u></a></li>
                <li class="breadcrumb-item active" aria-current="page">Training</li>
            </ol>
        </nav>
    </div>
</div>
<div class="py-5">
  <div class="container">
    <div class="row justify-content-center">
      <div class="col-lg-5 text-start">
        <h5 class="subtitle mb-4 text-pry">Become a Snyder HemBand-trained physician today</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 to ensure best-in-class education.</p>
        <p>Fill out the form below to schedule a personalized training session with our team of experts. </p>
      </div>
      <div class="col-lg-6 offset-lg-1">
        <img src="{{asset('img/pc-top.png')}}" class="w-100" alt="">
      </div>
    </div>
  </div>
</div>
<div class="bg-light">
  <div class="container py-5">
    <div class="row justify-content-center">
      <div class="col-lg-8">
        <h5 class="header mb-4">Schedule a Session</h5>
        <form class="" action="" method="post">
          @csrf
          <div class="row">
            <div class="col-lg-4 form-group mb-4">
              <label>First Name <span class="text-danger">*</span> </label>
              <input type="text" class="form-control rounded-0 py-3" required name="name_first" value="{{ old('name_first') }}">
            </div>
            <div class="col-lg-4 form-group mb-4">
              <label>Last Name <span class="text-danger">*</span> </label>
              <input type="text" class="form-control rounded-0 py-3" required name="name_last" value="{{ old('name_last') }}">
            </div>
            <div class="col-lg-4 form-group mb-4">
              <label>Practice Name <span class="text-danger">*</span> </label>
              <input type="text" class="form-control rounded-0 py-3" required name="practice_name" value="{{ old('practice_name') }}">
            </div>
          </div>
          <div class="row">
            <div class="col-lg-6 form-group mb-4">
              <label>Contact Email <span class="text-danger">*</span> </label>
              <input type="email" class="form-control rounded-0 py-3" required name="email" value="{{ old('email') }}">
            </div>
            <div class="col-lg-6 form-group mb-4">
              <label>Contact Phone Number <span class="text-danger">*</span> </label>
              <input type="tel" class="form-control rounded-0 py-3 phone" required name="phone" placeholder="(xxx) xxx-xxxx" value="{{ old('phone') }}">
            </div>
          </div>
          <div class="form-group mb-4">
            <label>Zip Code <span class="text-danger">*</span> </label>
            <input type="text" class="form-control rounded-0 py-3" required name="zip" value="{{ old('zip') }}">
          </div>
          <div class="form-group mb-4">
            <label>Training Type <span class="text-danger">*</span> </label>
            <select class="form-control rounded-0 py-3" onchange="return showField(this, 'other')" required name="training_type">
              <option value="">Select</option>
              <option value="clinical">Clinical Training</option>
              <option value="staff">Staff Training</option>
              <option value="other">Other</option>
            </select>
          </div>
          <div class="form-group mb-4 training_type d-none">
            <label>Other <span class="text-danger">*</span> </label>
            <input type="text" class="form-control rounded-0 py-3" required name="training_type_other" value="{{ old('training_type_other') }}">
          </div>
          <div class="form-group mb-4">
            <label>Training Format <span class="text-danger">*</span> </label>
            <select class="form-control rounded-0 py-3" required name="training_type">
              <option value="">Select</option>
              <option value="clinical">Clinical Training</option>
              <option value="staff">Staff Training</option>
              <option value="other">Other</option>
            </select>
          </div>
          <div class="form-group mb-4">
            <label>Other notes</label>
            <textarea name="message" class="form-control rounded-0" rows="6">{{ old('message') }}</textarea>
          </div>
          <button type="submit" class="btn btn-pry w-100 py-3">SUBMIT</button>
        </form>

        <p class="mt-lg-5 mt-4 mb-0 text-center">If you are already a partner and need assistance, please contact us at <b><a href="mailto:info@snyderhemband.org">info@snyderhemband.org</a></b> </p>
      </div>
    </div>
  </div>
</div>
<script type="text/javascript">
  function showField(_elem, _trigger) {
    var name = _elem.name;
    var val = $(_elem).val();
    if (val == _trigger) {
      $('.'+name).removeClass('d-none')
    }else {
      $('.'+name).addClass('d-none');
    }
  }
</script>
@endsection