@extends('frontend.layouts.app')
@section('title', 'Digital Blood Hub - Feedback')
@section('content')

    <div class="overlay"></div>
    <div class="loader"></div>

    <div class="checkout-wrapper space-top space-extra-bottom">
        <div class="container">
            @include('frontend.layouts.include.message')
            <form action="{{ route('feedback.submit') }}" method="POST" class="woocommerce-checkout" id="registrationForm">
                @csrf

                <div class="row gx-60 gy-60">
                    <div class="col-lg-12">
                        <div class="registerformwrapper">
                            <div class="row gx-60 gy-60">
                                <div class="col-lg-12">
                                    <div class="row">
                                        <div class="formheader mb-5 text-center">
                                            <h3>FEEDBACK</h3>
                                        </div>
                                        <div class="col-xl-6 col-lg-6 col-md-6 col-sm-12 col-12 form-group mb-4">
                                            <label>Patient Name<span class="text-danger">*</span></label>
                                            <input type="text" class="form-control" placeholder="" readonly
                                                name="" value="{{$feedback->requestBlood->patient_name ?? 'N/A'}}">
                                        
                                        </div>
                                        <div class="col-xl-6 col-lg-6 col-md-6 col-sm-12 col-12 form-group mb-4">
                                            <label>Hospital Name<span class="text-danger">*</span></label>
                                            <input type="text" class="form-control" placeholder=""
                                                name="" value="{{$feedback->requestBlood->Hospital->name ?? 'N/A'}}" readonly>
                                        
                                        </div>
                                        <div class="col-xl-6 col-lg-6 col-md-6 col-sm-12 col-12 form-group mb-4">
                                            <label>Donation Date<span class="text-danger">*</span></label>
                                            <input type="text" class="form-control" placeholder="" readonly
                                                name="" value="{{ \Carbon\Carbon::parse($feedback->requestBlood->require_date)->format('d M Y') }}" readonly>
                                        
                                        </div>
                                        <div class="col-xl-6 col-lg-6 col-md-6 col-sm-12 col-12 form-group mb-4">
                                            <label>Age<span class="text-danger">*</span></label>
                                            <input type="text" class="form-control" placeholder=""
                                                name="" value="{{$feedback->requestBlood->gender ?? 'N/A'}}" readonly>
                                        
                                        </div>
                                        <div class="col-xl-12 col-lg-12 col-md-12 col-sm-12 col-12 form-group mb-4">
                                            <label>Your Feedback<span class="text-danger">*</span></label>
                                            <input type="text" class="form-control" placeholder="Enter Your Feedback"
                                                name="feedback_text" value="">
                                            <input type="hidden" name="feedback_id" value="{{ $feedback->id }}">
                                            @error('feedback_text')
                                                <span class="text-danger">{{ $message }}</span>
                                            @enderror
                                        </div>

                                        <div class="row">
                                            <div class="col-xl-6 col-lg-6 col-md-6 col-sm-12 col-12 form-group">
                                                <div class="woocommerce-checkout-payment">
                                                    <div class="form-row place-order">
                                                        <button type="submit" class="btn">
                                                            <span class="link-effect">
                                                                <span class="effect-1">SUBMIT FEEDBACK</span>
                                                                <span class="effect-1">SUBMIT FEEDBACK</span>
                                                            </span>
                                                        </button>
                                                    </div>
                                                </div>
                                            </div>

                                        </div>

                                    </div>
                                </div>
                            </div>
                        </div>

                    </div>
            </form>

            <div class="mt-lg-3 mb-30">
                <div class="woocommerce-checkout-payment">


                </div>
            </div>
        </div>
    </div>
@endsection
@section('customJs')
    <script>
        $(document).ready(function() {

        });
    </script>
@endsection