98 lines
4.2 KiB
PHP
98 lines
4.2 KiB
PHP
<!DOCTYPE html>
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<html lang="en">
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<head>
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<meta charset="UTF-8">
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<meta name="viewport" content="width=device-width, initial-scale=1">
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<title>Register</title>
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<link href="https://cdn.jsdelivr.net/npm/bootstrap@5.3.0/dist/css/bootstrap.min.css" rel="stylesheet">
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<link rel="stylesheet" href="https://cdnjs.cloudflare.com/ajax/libs/font-awesome/6.5.0/css/all.min.css">
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<script src="https://cdn.jsdelivr.net/npm/bootstrap@5.3.0/dist/js/bootstrap.bundle.min.js"></script>
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<link rel="stylesheet" href="<?= base_url('css/app.css') ?>">
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<link rel="stylesheet" href="https://cdnjs.cloudflare.com/ajax/libs/font-awesome/6.5.0/css/all.min.css">
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</head>
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<body class="app-body app-page--auth">
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<?php $validationErrors = validation_errors(); ?>
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<div class="card auth-card shadow">
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<div class="card-body">
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<h2 class="text-center mb-4 auth-title">Create account</h2>
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<?php if (session()->getFlashdata('error')): ?>
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<div class="alert alert-danger app-alert"><?= esc(session()->getFlashdata('error')) ?></div>
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<?php endif; ?>
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<form method="post" action="<?= base_url('register') ?>" class="app-form" novalidate>
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<?= csrf_field() ?>
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<div class="mb-3">
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<?php
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echo view('components/name_field', [
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'fieldName' => 'first_name',
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'fieldLabel' => 'First name',
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'fieldId' => 'first_name',
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'fieldValue' => old('first_name', $first_name ?? ''),
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'required' => true,
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'validationErrors' => $validationErrors,
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'placeholder' => 'Enter first name'
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]);
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?>
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</div>
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<div class="mb-3">
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<?php
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echo view('components/name_field', [
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'fieldName' => 'last_name',
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'fieldLabel' => 'Last name',
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'fieldId' => 'last_name',
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'fieldValue' => old('last_name', $last_name ?? ''),
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'required' => true,
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'validationErrors' => $validationErrors,
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'placeholder' => 'Enter last name'
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]);
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?>
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</div>
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<div class="mb-3">
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<label class="form-label" for="email">Email <span class="text-danger">*</span></label>
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<input type="email" name="email" id="email" value="<?= esc(old('email')) ?>"
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class="form-control <?= isset($validationErrors['email']) ? 'is-invalid' : '' ?>"
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placeholder="Email address" autocomplete="email" required>
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<?= validation_show_error('email') ?>
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</div>
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<div class="mb-3">
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<label class="form-label" for="phone">
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Phone <span class="text-danger">*</span>
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</label>
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<div class="input-group">
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<span class="input-group-text">+91</span>
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<input type="tel" name="phone" id="phone" pattern="[0-9]{10}" maxlength="10"
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value="<?= esc(old('phone')) ?>"
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class="form-control <?= isset($validationErrors['phone']) ? 'is-invalid' : '' ?>"
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placeholder="Enter phone number"
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autocomplete="tel"
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required>
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</div>
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<?= validation_show_error('phone') ?>
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</div>
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<div class="mb-3">
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<?= view('components/password_field', ['id' => 'password']) ?>
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</div>
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<p class="small text-muted mb-4">Register as a <strong>patient</strong> to book appointments.</p>
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<button type="submit" class="btn btn-app-primary w-100">Register</button>
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</form>
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<div class="text-center mt-4">
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<p class="auth-divider-text mb-2">Already have an account?</p>
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<a href="<?= base_url('/') ?>" class="btn-app-secondary">Back to login</a>
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</div>
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</div>
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</div>
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</body>
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</html>
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