@extends('auth.register.layout')

@section('content')
    <div class="onboarding-content-box">
        <div class="onboarding-title profile-title">
            <img src="{{asset(optional(InfosSystem())->logo_color)}}'" height="50px" alt="">
            <h2>{{$pagename ?? ""}} <span>Patient</span></h2>
        </div>
        <div class="onboarding-content passcode-wrap mail-box">
            <form  method="post" action="{{route('website.auth.register.valide', $role)}}">@csrf
                <div class="row">

                    <div class="col-lg-6">
                        <div class="form-group">
                            <label class="onboarding-lable" for="first_name">Prénom<span>*</span></label>
                            <input type="text" id="first_name" name="first_name" class="form-control placeholder-style" required="">
                        </div>
                    </div>
                    <div class="col-lg-6">
                        <div class="form-group">
                            <label class="onboarding-lable" for="last_name">Nom de famille<span>*</span></label>
                            <input type="text" id="last_name" name="last_name" class="form-control placeholder-style" required="">
                        </div>
                    </div>
                    <div class="col-lg-6">
                        <div class="form-group">
                            <label class="onboarding-lable" for="gender">Genre <span>*</span></label>
                            <select class="select" name="gender" id="gender">
                                <option disabled selected>Veillez choisir</option>
                                <option>Homme</option>
                                <option>Femme</option>
                            </select>
                        </div>
                    </div>
                    <div class="col-lg-6">
                        <div class="form-group">
                            <label class="onboarding-lable" for="email">Email<span>*</span></label>
                            <input type="text" id="email" name="email" class="form-control placeholder-style" required="">
                        </div>
                    </div>
                    <div class="col-lg-6">
                        <div class="form-group">
                            <label class="onboarding-lable">Indicatif téléphonique <span>*</span></label>
                            <select name="country_code" class="select" id="country_code">
                                @foreach (Countries() as $pays)
                                    <option value="{{"+".$pays->country_code}}" @if ("+221" == $pays->country_code) selected @endif>{{"+".$pays->country_code." ".$pays->name}}
                                    </option>
                                @endforeach
                            </select>
                        </div>
                    </div>
                    <div class="col-lg-6">
                        <div class="form-group">
                            <label class="onboarding-lable" for="suffix_phone">Téléphone<span>*</span></label>
                            <input type="number" id="suffix_phone" name="suffix_phone" class="form-control placeholder-style" required="">
                        </div>
                    </div>
                    <div class="col-lg-6">
                        <div class="form-group">
                            <label class="onboarding-lable" for="password">Mot de passe<span>*</span></label>
                            <input type="password" id="password" name="password" class="form-control placeholder-style" required="">
                        </div>
                    </div>
                    <div class="col-lg-6">
                        <div class="form-group">
                            <label class="onboarding-lable" for="password_confirmation">Confirmation de mot de passe<span>*</span></label>
                            <input type="password" id="password_confirmation" name="password_confirmation" class="form-control placeholder-style" required="">
                        </div>
                    </div>
                </div>
                <div class="onboarding-btn d-flex justify-content-between Personalize-btn">
                    <a href="{{route('register')}}"   class="btn btn-danger btn-sm text-light">Retourner en arrière</a>
                    <button type="submit"  class="btn btn-success text-dark">Valider mon inscription</button>

                </div>
            </form>
        </div>
    </div>
@endsection