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person-programmer
2025-12-02 13:27:19 +07:00
parent 461a740be0
commit 9c590d0dbf
100 changed files with 3677 additions and 119 deletions
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resources/views/Admin/add_customer.blade.php
+31 -12
View File
@@ -7,40 +7,59 @@
<div class="row justify-content-center">
<div class="col-lg-7">
<div class="card shadow-lg border-0 rounded-lg mt-5">
<div class="card-header"><h1 class="text-center font-weight-light my-4"><b>Add New Customer</b></h1></div>
<div class="card-header"><h1 class="text-center font-weight-light my-4"><b>Tambahkan Pasien</b></h1></div>
<div class="card-body">
<form method="POST" action="{{ url('/insert-customer') }}" enctype="multipart/form-data">
@csrf
<div class="form-row">
<div class="col-md-6">
<div class="form-check">
<div class="col-md-20">
<div class="form-group">
<label class="small mb-1" for="inputFirstName">Customer Name</label>
<label class="small mb-1" for="inputFirstName">Tipe Pasien</label>
<div class="form-check">
<input class="form-check-input" type="radio" name="tipepasien" id="flexRadioDefault1">
<label class="form-check-label" for="flexRadioDefault1">
Pasien Baru
</label>
</div>
<div class="form-check">
<input class="form-check-input" type="radio" name="tipepasien" id="flexRadioDefault1">
<label class="form-check-label" for="flexRadioDefault1">
Pasien Lama
</label>
</div>
<div class="col-md-20">
<div class="form-group">
<label class="small mb-1" for="inputFirstName">Nama Pasien</label>
<input class="form-control py-4" name="name" type="text" placeholder="" />
</div>
</div>
<div class="col-md-6">
<div class="col-md-20">
<div class="form-group">
<label class="small mb-1" for="inputFirstName">Customer Email</label>
<label class="small mb-1" for="inputFirstName">Email</label>
<input class="form-control py-4" name="email" type="text" placeholder="" />
</div>
</div>
<div class="col-md-6">
<div class="col-md-20">
<div class="form-group">
<label class="small mb-1" for="inputLastName">Company</label>
<label class="small mb-1" for="inputLastName">No BPJS</label>
<input class="form-control py-4" name="company" type="text" placeholder="" />
</div>
</div>
<div class="col-md-6">
<div class="col-md-20">
<div class="form-group">
<label class="small mb-1" for="inputLastName">Address</label>
<label class="small mb-1" for="inputLastName">Alamat</label>
<input class="form-control py-4" name="address" type="text" placeholder="" />
</div>
</div>
<div class="col-md-6">
<div class="col-md-20">
<div class="form-group">
<label class="small mb-1" for="inputLastName">Phone</label>
<label class="small mb-1" for="inputLastName">No Telepon</label>
<input class="form-control py-4" name="phone" type="text" placeholder="" />
</div>
</div>