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

New Patient

@if (session('message'))

{{ session('message') }}

@endif

First Name *

Last Name *

@if($pro->pro_type === 'ADMIN')

MCP Pro

Default NA Pro

@elseif($pro->is_hcp === true)

MCP Pro

@elseif($pro->isDefaultNA())

MCP Pro teamsWhereAssistant; ?>

Default NA Pro

@endif

Sex

Date Of Birth *

Home Phone Number

Cell Phone Number

Email Address

Insurance

Medicare Non-Medicare

Medicare Number

Payer

Member ID

How did you hear about us?

@endsection