@extends('frontend.layout')

@section('content')
<section class="appointment-section pos-r pt-80">

  <div class="booking-section">

    <div class="container">

      <div class="row">

        <div class="col-sm-12">

          <div class="left-block" > <img src="{{asset('assets/img/network.jpg')}}" alt="" /> </div>

          <div class="right-block ">
 <div class="appointment">
    <h2>Join MTM Network</h2>

    @if(session('success'))
        <div class="alert alert-success">
            {{ session('success') }}
        </div>
    @endif

    <form action="{{ route('network.store') }}" method="POST">
        @csrf

        <div class="form-group">
            <label for="fullName">Full Name:</label>
            <input type="text" name="FullName" id="fullName" class="input-sm form-full" required>
        </div>

        <div class="form-group">
            <label for="email">Email:</label>
            <input type="email" name="Email" id="email" class="input-sm form-full" required>
        </div>

        <div class="form-group">
            <label for="phoneNumber">Phone Number:</label>
            <input type="text" name="PhoneNumber" id="phoneNumber" class="input-sm form-full" required>
        </div>

        <div class="form-group">
            <label for="joinAs">Join As:</label>
            <select name="JoinAs" id="joinAs" class="input-sm form-full" required>
                <option value="MTM Provider">MTM Provider</option>
                <option value="Pharmacist">Pharmacist</option>
                <option value="Patient">Patient</option>
                <option value="Payer">Payer</option>
            </select>
        </div>

        <div class="form-group">
            <label for="country">Country:</label>
            <input type="text" name="Country" id="country" class="input-sm form-full" required>
        </div>

        <div class="form-group">
            <label for="city">City:</label>
            <input type="text" name="City" id="city" class="input-sm form-full" required>
        </div>

        <button type="submit" class="btn btn-primary">Join Now</button>
    </form>
    <br/><br/>
  </div></div></div></div></section>
@endsection