@extends('frontend.layouts.master')
@section('content')
    <div class="container">
        <style>
            .sartajcard {
                box-shadow: rgba(0, 0, 0, 0.25) 0px 54px 55px, rgba(0, 0, 0, 0.12) 0px -12px 30px, rgba(0, 0, 0, 0.12) 0px 4px 6px, rgba(0, 0, 0, 0.17) 0px 12px 13px, rgba(0, 0, 0, 0.09) 0px -3px 5px;

            }

            .feedbackformheader {
                background-color: rgb(103, 58, 183);
                width: 70%;
                /* Set a width for the div */
                margin: 0 auto;
                /* Set margin to "auto" to center horizontally */
                height: 7px;
                border-top-left-radius: 15px;
                border-top-right-radius: 15px;


            }
        </style>
        <div class="row">
            <div class="col-md-12 col-sm-12">
                <div class="feedbackformheader">
                </div>
            </div>
            <div class="d-flex justify-content-center">
                <div class="col-md-8">
                    <div class="row">

                        <div class="card">
                            <div class="sartajcard">
                                <div class="card-header">
                                    <h3 class="justify-content-center" style=" font-family:docs-Roboto;text-align:center">
                                        <b>Madalasa Hospital Feedback Form</b>
                                    </h3>
                                    <p
                                        style="text-align: justify; font-family:docs-Roboto;font-size:13pt;font-weight:400;line-height: 1.5">
                                        Thank you for choosing Madalasa Hospital for your medical care. We have taken
                                        several measures to ensure that the services we provide meet your expectations.
                                        However, we value your feedback to help us improve our services further. We kindly
                                        request you to complete this feedback form. Your comments are highly valuable to us,
                                        and we assure you that we will take appropriate actions to implement your
                                        suggestions, within our practical constraints.
                                    </p>
                                </div>
                                <div class="card-body" style=" font-family:docs-Roboto;">
                                    <form action="{{ route('hospitalfeedback.store') }}" method="POST">
                                        @csrf
                                        @if (session('success'))
                                        <div class="alert alert-success">
                                            {{ session('success') }}
                                        </div>
                                        @if (session('positive'))
                                            <script>
                                                setTimeout(function() {
                                                    window.location.href = 'https://g.page/r/CehchoT-uepXEBM/review';
                                                }, 3000); // Redirect after 3 seconds
                                            </script>
                                        @endif
                                    @endif
                                        @if (session('error'))
                                            <div class="alert alert-danger">
                                                {{ session('error') }}
                                            </div>
                                        @endif

                                        @if ($errors->any())
                                            <div class="alert alert-danger">
                                                <ul>
                                                    @foreach ($errors->all() as $error)
                                                        <li>{{ $error }}</li>
                                                    @endforeach
                                                </ul>
                                            </div>
                                        @endif

                                        <div class="row">
                                            <div class="form-group col-md-4">
                                                <label for="" class="form-label">Patient Name*:</label>
                                                <input type="text" name="name" class="form-control">
                                            </div>
                                            <div class="form-group col-md-4">
                                                <label for="" class="form-label">Mobile No* :</label>
                                                <input type="text" name="phone" class="form-control">
                                            </div>
                                            <div class="form-group col-md-4">
                                                <label for="" class="form-label">Email :</label>
                                                <input type="text" name="email" class="form-control">
                                            </div>
                                            <div class="form-group col-md-4">
                                                <label>Q1: How would you rate the environment at Madalasa Hospital?</label>
                                                <div>
                                                    <input type="radio" name="q1" value="Very Good"> Very Good
                                                </div>
                                                <div>
                                                    <input type="radio" name="q1" value="Good"> Good
                                                </div>
                                                <div>
                                                    <input type="radio" name="q1" value="Fair"> Fair
                                                </div>
                                                <div>
                                                    <input type="radio" name="q1" value="Average"> Average
                                                </div>
                                                <div>
                                                    <input type="radio" name="q1" value="Poor"> Poor
                                                </div>
                                            </div>
                                            <div class="form-group col-md-4">
                                                <label>Q2:How would you rate the approach of the doctors at Madalasa
                                                    Hospital?</label>
                                                <div>
                                                    <input type="radio" name="q2" value="Very Good"> Very Good
                                                </div>
                                                <div>
                                                    <input type="radio" name="q2" value="Good"> Good
                                                </div>
                                                <div>
                                                    <input type="radio" name="q2" value="Fair"> Fair
                                                </div>
                                                <div>
                                                    <input type="radio" name="q2" value="Average"> Average
                                                </div>
                                                <div>
                                                    <input type="radio" name="q2" value="Poor"> Poor
                                                </div>
                                            </div>
                                            <div class="form-group col-md-4">
                                                <label>Q3:How would you rate the approach of the dietitians at Madalasa
                                                    Hospital?</label>
                                                <div>
                                                    <input type="radio" name="q3" value="Very Good"> Very Good
                                                </div>
                                                <div>
                                                    <input type="radio" name="q3" value="Good"> Good
                                                </div>
                                                <div>
                                                    <input type="radio" name="q3" value="Fair"> Fair
                                                </div>
                                                <div>
                                                    <input type="radio" name="q3" value="Average"> Average
                                                </div>
                                                <div>
                                                    <input type="radio" name="q3" value="Poor"> Poor
                                                </div>
                                            </div>
                                            <div class="form-group col-md-4">
                                                <label>Q4:How would you rate the food/diet at Madalasa Hospital?</label>
                                                <div>
                                                    <input type="radio" name="q4" value="Very Good"> Very Good
                                                </div>
                                                <div>
                                                    <input type="radio" name="q4" value="Good"> Good
                                                </div>
                                                <div>
                                                    <input type="radio" name="q4" value="Fair"> Fair
                                                </div>
                                                <div>
                                                    <input type="radio" name="q4" value="Average"> Average
                                                </div>
                                                <div>
                                                    <input type="radio" name="q4" value="Poor"> Poor
                                                </div>
                                            </div>
                                            <div class="form-group col-md-4">
                                                <label>Q5:How would you rate the service provided by the attending nurses at
                                                    Madalasa Hospital?</label>
                                                <div>
                                                    <input type="radio" name="q5" value="Very Good"> Very Good
                                                </div>
                                                <div>
                                                    <input type="radio" name="q5" value="Good"> Good
                                                </div>
                                                <div>
                                                    <input type="radio" name="q5" value="Fair"> Fair
                                                </div>
                                                <div>
                                                    <input type="radio" name="q5" value="Average"> Average
                                                </div>
                                                <div>
                                                    <input type="radio" name="q5" value="Poor"> Poor
                                                </div>
                                            </div>
                                            <div class="form-group col-md-4">
                                                <label>Q6:How would you rate the hospital billing process at Madalasa
                                                    Hospital?</label>
                                                <div>
                                                    <input type="radio" name="q6" value="Very Good"> Very Good
                                                </div>
                                                <div>
                                                    <input type="radio" name="q6" value="Good"> Good
                                                </div>
                                                <div>
                                                    <input type="radio" name="q6" value="Fair"> Fair
                                                </div>
                                                <div>
                                                    <input type="radio" name="q6" value="Average"> Average
                                                </div>
                                                <div>
                                                    <input type="radio" name="q6" value="Poor"> Poor
                                                </div>
                                            </div>
                                            <div class="form-group col-md-4">
                                                <label>Q7:How would you rate the admission process at Madalasa
                                                    Hospital?</label>
                                                <div>
                                                    <input type="radio" name="q7" value="Very Good"> Very Good
                                                </div>
                                                <div>
                                                    <input type="radio" name="q7" value="Good"> Good
                                                </div>
                                                <div>
                                                    <input type="radio" name="q7" value="Fair"> Fair
                                                </div>
                                                <div>
                                                    <input type="radio" name="q7" value="Average"> Average
                                                </div>
                                                <div>
                                                    <input type="radio" name="q7" value="Poor"> Poor
                                                </div>
                                            </div>
                                            <div class="form-group col-md-4">
                                                <label>Q8:How would you rate the discharge process at Madalasa
                                                    Hospital?</label>
                                                <div>
                                                    <input type="radio" name="q8" value="Very Good"> Very Good
                                                </div>
                                                <div>
                                                    <input type="radio" name="q8" value="Good"> Good
                                                </div>
                                                <div>
                                                    <input type="radio" name="q8" value="Fair"> Fair
                                                </div>
                                                <div>
                                                    <input type="radio" name="q8" value="Average"> Average
                                                </div>
                                                <div>
                                                    <input type="radio" name="q8" value="Poor"> Poor
                                                </div>
                                            </div>
                                            <div class="form-group col-md-4">
                                                <label>Q9:Overall, how would you rate your experience at Madalasa
                                                    Hospital?</label>
                                                <div>
                                                    <input type="radio" name="q9" value="Very Good"> Very Good
                                                </div>
                                                <div>
                                                    <input type="radio" name="q9" value="Good"> Good
                                                </div>
                                                <div>
                                                    <input type="radio" name="q9" value="Fair"> Fair
                                                </div>
                                                <div>
                                                    <input type="radio" name="q9" value="Average"> Average
                                                </div>
                                                <div>
                                                    <input type="radio" name="q9" value="Poor"> Poor
                                                </div>
                                            </div>
                                            <div class="form-group col-md-12">
                                                <label for="suggestion">Suggestions:</label>
                                                <textarea name="suggestion" id="suggestion" class="form-control" rows="4"></textarea>
                                            </div>
                                            <div class="form-group col-md-12" style="text-align: center">
                                                <button type="submit" class="btn btn-primary">Submit Now</button>
                                            </div>
                                        </div>


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

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

        </div>
    </div>



@endsection