<?php $__env->startSection('content'); ?>
    <section class="inner_header">
        <img src="<?php echo e(asset('assets/web/images/icons/inner.svg')); ?>" alt="" class="inner_shap">
        <div class="container">
            <ul class="links">
                <li>
                    <a href="<?php echo e(LaravelLocalization::getLocalizedURL($lang, route('home'), [], true)); ?>">الرئيسية</a>
                </li>
                <li>
                    <a href="#"> طلب توثيق </a>
                </li>
            </ul>
            <h4>طلب توثيق</h4>
        </div>
    </section>
    <section class="consultation-pg section_padding">
        <div class="container">
            <div class="form-container">
                <form>
                    <div class="doc-wrapper">
                        <div class="row justify-content-center">
                            <div class="col-md-4">
                                <div class="form-check">
                                    <input class="form-check-input" type="radio" name="type" id="inside_office">
                                    <label class="form-check-label color1" for="inside_office">
                                        <div class="icon-outer">
                                            <img src="<?php echo e(asset('assets/web/images/icons/workplace.svg')); ?>" alt="" class="icon"/>
                                        </div>
                                        <h5 class="title mb-0">توثيق داخل المكتب</h5>
                                    </label>
                                </div>
                            </div>
                            <div class="col-md-4">
                                <div class="form-check">
                                    <input class="form-check-input" type="radio" name="type" id="outside_office">
                                    <label class="form-check-label color2" for="outside_office">
                                        <div class="icon-outer">
                                            <img src="<?php echo e(asset('assets/web/images/icons/workplace.svg')); ?>" alt="" class="icon"/>
                                        </div>
                                        <h5 class="title mb-0">توثيق خارج المكتب</h5>
                                    </label>
                                </div>
                            </div>
                        </div>
                    </div>
                    <div class="row justify-content-between mt-5 pt-3">
                        <div class="col-md-6">
                            <div class="form-group">
                                <select name="city_id" class="form-control">
                                    <option disabled value="">المدينه</option>
                                    <?php if(count($cities)): ?>
                                        <?php $__currentLoopData = $cities; $__env->addLoop($__currentLoopData); foreach($__currentLoopData as $city): $__env->incrementLoopIndices(); $loop = $__env->getLastLoop(); ?>
                                            <option value="<?php echo e($city->id); ?>"><?php echo e($city->name); ?></option>
                                        <?php endforeach; $__env->popLoop(); $loop = $__env->getLastLoop(); ?>
                                    <?php endif; ?>
                                </select>
                            </div>
                        </div>
                        <div class="col-md-6">
                            <div class="form-group">
                                <select name="documentation_type_id" class="form-control">
                                    <option disabled value="">نوع طلب التوثيق</option>
                                    <?php if(count($documentationTypes)): ?>
                                        <?php $__currentLoopData = $documentationTypes; $__env->addLoop($__currentLoopData); foreach($__currentLoopData as $documentationType): $__env->incrementLoopIndices(); $loop = $__env->getLastLoop(); ?>
                                            <option value="<?php echo e($documentationType->id); ?>"><?php echo e($documentationType->name); ?></option>
                                        <?php endforeach; $__env->popLoop(); $loop = $__env->getLastLoop(); ?>
                                    <?php endif; ?>
                                </select>
                            </div>
                        </div>
                    </div>
                    <div class="row mt-5 pt-3">
                        <div class="col-md-6">
                            <h5 class="title text-dark mb-4"><b>نبذة عن طب التوثيق</b></h5>
                            <textarea name="notes" class="form-control" rows="12"></textarea>
                        </div>
                        <div class="col-md-6">
                            <h5 class="title text-dark mb-4"><b>تحديد الموقع</b></h5>
                            <div class="map-box">
                                <iframe width="100%" height="300" frameborder="0" scrolling="no" marginheight="0" marginwidth="0" src="https://maps.google.com/maps?width=100%25&amp;height=600&amp;hl=en&amp;q=1%20Grafton%20Street,%20Dublin,%20Ireland+(My%20Business%20Name)&amp;t=&amp;z=14&amp;ie=UTF8&amp;iwloc=B&amp;output=embed"><a href="https://www.gps.ie/truck-gps/">delivery van gps</a></iframe>
                            </div>
                        </div>
                    </div>
                    <div class="date-outer mt-5">
                        <h5 class="title text-dark mb-4"><b><i class="bi bi-calendar3 me-2"></i> تاريخ طلب التوثيق</b></h5>
                        <div class="date-inner">
                            <?php if(count($documentations)): ?>
                                <?php $__currentLoopData = $documentations; $__env->addLoop($__currentLoopData); foreach($__currentLoopData as $documentation): $__env->incrementLoopIndices(); $loop = $__env->getLastLoop(); ?>
                                    <div class="form-check">
                                        <input data-documentation="<?php echo e($documentation->id); ?>" class="form-check-input documentation_date" type="radio" name="documentation_date" id="documentation_date_<?php echo e($loop->iteration); ?>" value="<?php echo e($documentation->documentation_date); ?>">
                                        <label class="form-check-label" for="documentation_date_<?php echo e($loop->iteration); ?>">
                                            <?php echo e(date('d/m/Y', strtotime($documentation->documentation_date))); ?>

                                        </label>
                                    </div>
                                <?php endforeach; $__env->popLoop(); $loop = $__env->getLastLoop(); ?>
                            <?php endif; ?>
                        </div>
                    </div>
                    <div class="date-outer mt-5">
                        <h5 class="title text-dark mb-4"><b><i class="bi bi-clock me-2"></i> وقت طلب التوثيق</b></h5>
                        <div class="date-inner">
                            <?php if(count($documentations)): ?>
                                <?php $__currentLoopData = $documentations; $__env->addLoop($__currentLoopData); foreach($__currentLoopData as $documentation): $__env->incrementLoopIndices(); $loop = $__env->getLastLoop(); ?>
                                    <div class="form-check">
                                        <input class="form-check-input" type="radio" name="documentation_time" id="documentation_time_<?php echo e($loop->iteration); ?>" value="<?php echo e($documentation->documentation_time); ?>">
                                        <label class="form-check-label" for="documentation_time_<?php echo e($loop->iteration); ?>">
                                            <?php echo e(date('h:i A', strtotime($documentation->documentation_time))); ?>

                                        </label>
                                    </div>
                                <?php endforeach; $__env->popLoop(); $loop = $__env->getLastLoop(); ?>
                            <?php endif; ?>
                        </div>
                    </div>
                    <p class="note mt-5">
                        <i class="bi bi-exclamation-circle"></i>
                        دوام المكتب من الثامنة صباحا وحتي الخمسة مساء لإستفسار معنا يرجي التواصل واتساب
                    </p>
                    <div class="payment_methods mt-5">
                        <h5 class="title text-dark mb-4"><b> خيارات الدفع</b></h5>
                        <div class="row">
                            <div class="col-md-6 mb-2">
                                <div class="form-check color3">
                                    <input class="form-check-input" type="radio" name="pay_way" id="visa_master" value="2">
                                    <label class="form-check-label" for="visa_master">
                                        Visa/Mastercard
                                        <img src="<?php echo e(asset('assets/web/images/icons/payment-3.svg')); ?>" alt="" class="icon">
                                    </label>
                                </div>
                            </div>
                            <div class="col-md-6 mb-2">
                                <div class="form-check color1">
                                    <input class="form-check-input" type="radio" name="pay_way" id="mada" value="6">
                                    <label class="form-check-label" for="mada">
                                        Mada
                                        <img src="<?php echo e(asset('assets/web/images/icons/payment-1.svg')); ?>" alt="" class="icon">
                                    </label>
                                </div>
                            </div>
                            <div class="col-md-6">
                                <div class="form-check color2">
                                    <input class="form-check-input" type="radio" name="pay_way" id="stc_pay" value="14">
                                    <label class="form-check-label" for="stc_pay">
                                        STC pay
                                        <img src="<?php echo e(asset('assets/web/images/icons/payment-2.svg')); ?>" alt="" class="icon">
                                    </label>
                                </div>
                            </div>
                            <div class="col-md-6">
                                <div class="form-check color2">
                                    <input class="form-check-input" type="radio" name="pay_way" id="apple_pay" value="11">
                                    <label class="form-check-label" for="apple_pay">
                                        APPLE pay
                                        <img src="<?php echo e(asset('assets/web/images/icons/payment-2.svg')); ?>" alt="" class="icon">
                                    </label>
                                </div>
                            </div>
                        </div>
                    </div>
                    <div class="row mt-5 mb-5">
                        <div class="col-md-6">
                            <h5 class="title text-dark mb-4"><b> كوبون الخصم </b></h5>
                            <div class="form-group copun-group">
                                <input name="coupon_code" class="form-control" placeholder="كوبون الخصم"/>
                                <a href="#" class="butn sub_butn check_coupon"><span> تطبيق </span></a>
                            </div>
                        </div>
                        <div class="col-md-6">
                            <h5 class="title text-dark mb-4 discount_title"><b> نسبة الخصم </b></h5>
                            <div class="form-group">
                                <input class="form-control discount_value" placeholder="10%" disabled/>
                            </div>
                        </div>
                    </div>
                    <div class="total_box text-center col-md-5 m-auto">
                        <h5 class="title main_color"><b>الإجمالي</b></h5>
                        <h1 class="price text-dark mt-3"><b class="total">2240</b> <small>ريال سعودي</small></h1>
                    </div>
                    <p class="note mt-3 col-md-4 m-auto">
                        <i class="bi bi-exclamation-circle"></i>
                        السعر شامل ضريبة القيمة المضافة
                    </p>
                    <button class="submit-butn butn mt-5 m-auto d-block documentation_request_button" type="button" data-bs-toggle="modal" data-bs-target="#confirmConsult"><span><b>إتمام طلب التوثيق</b></span></button>

                </form>
            </div>
        </div>
    </section>
<?php $__env->stopSection(); ?>

<!-- ------------ modals ----------- -->
<div class="modal confirmConsult fade" id="confirmConsult" tabindex="-1" aria-labelledby="exampleModalLabel" aria-hidden="true">
    <div class="modal-dialog modal-dialog-centered modal-lg">
        <div class="modal-content">
            <button type="button" class="btn-close" data-bs-dismiss="modal" aria-label="Close"></button>
            <div class="modal-body">
                <img src="<?php echo e(asset('assets/web/images/icons/confirm.png')); ?>" alt="" class="icon"/>
                <div class="content text-center mt-4">
                    <h3 class="title text-dark mb-2"><b>تم طلب التوثيق بنجاح</b></h3>
                    <p class="text">
                        تم طلب الاستشارة بنجاح، برجاء الحضور للمكتب في التاريخ والوقت الذي تم تحديده
                    </p>
                </div>
            </div>
        </div>
    </div>
</div>


<?php $__env->startSection('inner_js'); ?>

<?php $__env->stopSection(); ?>

<?php echo $__env->make('web.layouts.container', \Illuminate\Support\Arr::except(get_defined_vars(), ['__data', '__path']))->render(); ?><?php /**PATH C:\wamp64\www\legal\resources\views/web/documentations/index.blade.php ENDPATH**/ ?>