forked from eatvio/eatvio-infra
68 lines
3.3 KiB
PHP
68 lines
3.3 KiB
PHP
@section('title', __('reg_form.title_' . $step))
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<div>
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<div class="modal-header">
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<h5 class="modal-title --medium_title">{{ __('reg_form.step4_head') }}</h5>
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</div>
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<div step-item class="modal-body">
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<div class="my-3 text-center">{{ __('reg_form.your_blood_pressure') }}</div>
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<div class="text-center --f_bold">{{ __('reg_form.average_pressure_readings') }}</div>
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<div class="row">
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<div class="col-6 @error('blood_pressure_up') verror @enderror">
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<div class="text-center --f_bold">{{ __('reg_form.pressure_up') }}</div>
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<input type="number" wire:model="blood_pressure_up" name="blood_pressure_up" class="form-control my-3 text-center" value="" />
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@if($errors->has('blood_pressure_up'))
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<div class="verror-message">{{ $errors->first('blood_pressure_up') }}</div>
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@endif
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</div>
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<div class="col-6 @error('blood_pressure_down') verror @enderror">
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<div class="text-center --f_bold">{{ __('reg_form.pressure_down') }}</div>
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<input type="number" wire:model="blood_pressure_down" name="blood_pressure_down" class="form-control my-3 text-center" value="" />
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@if($errors->has('blood_pressure_down'))
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<div class="verror-message">{{ $errors->first('blood_pressure_down') }}</div>
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@endif
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</div>
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</div>
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<div class="text-center --f_bold">{{ __('reg_form.tendency_to_be_hypo') }}</div>
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<div class="--with_arr my-3 @error('has_hypo') verror @enderror">
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<select class="form-select text-center" wire:model="has_hypo" name="has_hypo">
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<option selected value="0">{{ __('reg_form.no') }}</option>
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<option value="1">{{ __('reg_form.yes') }}</option>
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</select>
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<span></span>
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@if($errors->has('has_hypo'))
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<div class="verror-message">{{ $errors->first('has_hypo') }}</div>
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@endif
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</div>
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<div class="text-center --f_bold">{{ __('reg_form.prone_to_hypertension') }}</div>
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<div class="--with_arr my-3 @error('has_hyper') verror @enderror">
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<select class="form-select text-center" wire:model="has_hyper" name="has_hyper">
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<option selected value="0">{{ __('reg_form.no') }}</option>
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<option value="1">{{ __('reg_form.yes') }}</option>
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</select>
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<span></span>
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@if($errors->has('has_hyper'))
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<div class="verror-message">{{ $errors->first('has_hyper') }}</div>
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@endif
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</div>
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<button class="mb-2 btn btn-lg btn-primary btn-block w-100 --f_bolder" type="button" next-step wire:click="nextStep">{{ __('reg_form.continue') }}</button>
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<div class="row">
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<div class="text-center --f_bold col-6">
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<a href="javascript:void(0)" skip-step wire:click="goBack">
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<span class="--f_grey">{{ __('reg_form.go_back') }}</span>
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</a>
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</div>
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<div class="text-center --f_bold col-6">
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<a href="javascript:void(0)" skip-step wire:click="skipStep">
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<span class="--f_grey">{{ __('reg_form.skip') }}</span>
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</a>
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</div>
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</div>
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</div>
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</div>
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