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-@extends('layouts.pro-logged-in')
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-@section('content')
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-
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- <div class="form-contents"><div class="failed-form-contents">
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-
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- <h4 class="d-flex m-0 p-3">
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- <div>My Clients: Add New</div>
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- <div class="ml-auto">
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- <a class="text-secondary" href="{{route('my_clients-index')}}" up-close>
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- <i class="fa fa-times"></i>
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- </a>
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- </div>
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- </h4>
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-
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- <form action="/post-to-api"
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- up-target="#main-content" up-history="false" up-fail-target=".failed-form-contents" up-reveal="true"
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- method="post" enctype="multipart/form-data"
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- class="border-top px-3 pt-3 pb-1 custom-submit">
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- @csrf
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-
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- @if (session('message'))
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- <div class="alert alert-danger">{{ session('message') }}</div>
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- @endif
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-
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- <input type="hidden" name="_api" value="/api/client/create">
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- <input type="hidden" name="_success" value="{{route('my_clients-index')}}">
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- <input type="hidden" name="_return" value="{{route('my_clients-add_new')}}">
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- <div class='form-group mb-3'>
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-<label class='control-label'>Team </label>
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-<select class='form-control' name='teamUid' value='{{ old('teamUid') ? old('teamUid') : '' }}' >
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-<option value=''>-- Select --</option>
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-<?php $dbOptions = \Illuminate\Support\Facades\DB::table('team')->get(); ?>
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-<?php foreach($dbOptions as $o): ?>
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-<option <?= $o->uid === (old('teamUid') ? old('teamUid') : '') ? 'selected' : '' ?> value='<?= $o->uid ?>'><?= $o->team_number ?> (<?= $o->uid ?>)</option>
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-<?php endforeach; ?>
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-</select>
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-</div>
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-<div class='form-group mb-3'>
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-<label class='control-label'>Mcp Pro </label>
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-<select class='form-control' name='mcpProUid' value='{{ old('mcpProUid') ? old('mcpProUid') : '' }}' >
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-<option value=''>-- Select --</option>
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-<?php $dbOptions = \Illuminate\Support\Facades\DB::table('pro')->get(); ?>
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-<?php foreach($dbOptions as $o): ?>
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-<option <?= $o->uid === (old('mcpProUid') ? old('mcpProUid') : '') ? 'selected' : '' ?> value='<?= $o->uid ?>'><?= $o->name_display ?> (<?= $o->uid ?>)</option>
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-<?php endforeach; ?>
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-</select>
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-</div>
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-<div class='form-group mb-3'>
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-<label class='control-label'>Ally Pro </label>
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-<select class='form-control' name='allyProUid' value='{{ old('allyProUid') ? old('allyProUid') : '' }}' >
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-<option value=''>-- Select --</option>
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-<?php $dbOptions = \Illuminate\Support\Facades\DB::table('pro')->get(); ?>
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-<?php foreach($dbOptions as $o): ?>
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-<option <?= $o->uid === (old('allyProUid') ? old('allyProUid') : '') ? 'selected' : '' ?> value='<?= $o->uid ?>'><?= $o->name_display ?> (<?= $o->uid ?>)</option>
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-<?php endforeach; ?>
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-</select>
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-</div>
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-<div class='form-group mb-3'>
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-<label class='control-label'>Name Display </label>
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-<input class='form-control' type='text' name='nameDisplay' value='{{ old('nameDisplay') ? old('nameDisplay') : '' }}' >
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-</div>
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-<div class='form-group mb-3'>
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-<label class='control-label'>Name Prefix </label>
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-<input class='form-control' type='text' name='namePrefix' value='{{ old('namePrefix') ? old('namePrefix') : '' }}' >
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-</div>
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-<div class='form-group mb-3'>
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-<label class='control-label'>Name First </label>
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-<input class='form-control' type='text' name='nameFirst' value='{{ old('nameFirst') ? old('nameFirst') : '' }}' >
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-</div>
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-<div class='form-group mb-3'>
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-<label class='control-label'>Name Middle </label>
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-<input class='form-control' type='text' name='nameMiddle' value='{{ old('nameMiddle') ? old('nameMiddle') : '' }}' >
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-</div>
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-<div class='form-group mb-3'>
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-<label class='control-label'>Name Last </label>
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-<input class='form-control' type='text' name='nameLast' value='{{ old('nameLast') ? old('nameLast') : '' }}' >
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-</div>
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-<div class='form-group mb-3'>
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-<label class='control-label'>Name Suffix </label>
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-<input class='form-control' type='text' name='nameSuffix' value='{{ old('nameSuffix') ? old('nameSuffix') : '' }}' >
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-</div>
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-<div class='form-group mb-3'>
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-<label class='control-label'>Name Credential </label>
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-<input class='form-control' type='text' name='nameCredential' value='{{ old('nameCredential') ? old('nameCredential') : '' }}' >
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-</div>
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-<div class='form-group mb-3'>
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-<label class='control-label'>Gender </label>
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-<select class='form-control' name='gender' value='{{ old('gender') ? old('gender') : '' }}' >
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-<option value=''>-- Select --</option>
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-<option <?= 'M' === (old('gender') ? old('gender') : '') ? 'selected' : '' ?> value='M'>M</option>
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-<option <?= 'F' === (old('gender') ? old('gender') : '') ? 'selected' : '' ?> value='F'>F</option>
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-</select>
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-</div>
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-<div class='form-group mb-3'>
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-<label class='control-label'>Date Of Birth </label>
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-<input class='form-control' type='date' name='dateOfBirth' value='{{ old('dateOfBirth') ? old('dateOfBirth') : '' }}' >
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-</div>
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-<div class='form-group mb-3'>
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-<label class='control-label'>Cell Number </label>
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-<input class='form-control' type='tel' name='cellNumber' value='{{ old('cellNumber') ? old('cellNumber') : '' }}' >
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-</div>
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-<div class='form-group mb-3'>
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-<label class='control-label'>Email Address </label>
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-<input class='form-control' type='email' name='emailAddress' value='{{ old('emailAddress') ? old('emailAddress') : '' }}' >
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-</div>
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-<div class='form-group mb-3'>
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-<label class='control-label'>Medicare Number </label>
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-<input class='form-control' type='text' name='medicareNumber' value='{{ old('medicareNumber') ? old('medicareNumber') : '' }}' >
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-</div>
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- <div class="form-group mb-3 d-flex justify-content-center">
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- <button class="btn btn-sm btn-primary mr-3 px-5">Submit</button>
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- <a href="{{route('my_clients-index')}}" class="btn btn-sm btn-default px-5" up-close>Cancel</a>
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- </div>
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- </form>
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-
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- </div></div>
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-
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-@endsection
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