HTTP/1.0 200 OK
Cache-Control: no-cache, private
Date:          Sat, 27 Apr 2024 10:46:10 GMT

<h6 class="subtitle-modal">A marcação será válida quando receber a confirmação por e-mail ou telefone</h6>
<!-- Capchca code -->
<script type="text/javascript">
    var widId = "";
    var onloadCallback=function() {
        widId = grecaptcha.render('appointment_captcha', {
            'sitekey' : '6LeoW3MaAAAAACm56Rol0YWmqcLoM_tJNXM3k7Gc',
            'theme' : 'light'
        });
    };   

    function verifyCaptcha(form) {
        var res = grecaptcha.getResponse(widId) ? true : false;
        return res;
    };
</script>
<form name="medical_appointment" method="post" action="/medical-appointment/new" onsubmit="return verifyCaptcha(this);">
    <div class="row margin-bottom-15">
        <div class="col-sm-6">
            <label class="required">Especialidades Médicas <samp>*</samp></label>
            <select name="medical_appointment[specialty]" class="form-control medical-appointment-specialty-select2" required>                
                                                                                            <option value="1" >Ginecologia</option>
                                                                            <option value="2" >Nutrição</option>
                                                                            <option value="3" >Anestesiologia</option>
                                                                            <option value="4" >Angiologia</option>
                                                                            <option value="5" >Medicina Interna</option>
                                                                            <option value="6" >Dermatologista</option>
                                                                            <option value="7" >Medicina Estética</option>
                                                                            <option value="14" >Ortopedia</option>
                                                                            <option value="15" >Cirurgia Plástica</option>
                                                                            <option value="16" >Endocrinologia</option>
                                                                            <option value="17" >Psiquiatria</option>
                                                                            <option value="18" >Urologia</option>
                                                                            <option value="19" >Máxilofacial</option>
                                                                            <option value="20" >Radiologia</option>
                                                                            <option value="21" >Cardiologia</option>
                                                                            <option value="22" >Pediatria</option>
                                                                            <option value="23" >Oftalmologia</option>
                                                                            <option value="26" >Unidade da dor</option>
                                                                            <option value="27" >Infectologia</option>
                                                                            <option value="28" >Otorrinolaringologia</option>
                                                                            <option value="30" >Neurologia</option>
                                                                            <option value="31" >ESTETICA</option>
                                                                            <option value="32" >Cirurgia Geral</option>
                                                                            <option value="33" >Gastroenterología</option>
                                                                            <option value="34" >Reprodução Assistida</option>
                            </select>
        </div>
        <div class="col-sm-6">
            <label class="required">Médicos</label>
            <select name="medical_appointment[staff]" class="form-control medical-appointment-staff-select2" data-path="/staff/specialties" data-selected="">                
                <option selected="selected"></option>
            </select>
        </div>
    </div>
    <div class="row margin-bottom-15">
        <div class="col-sm-6">
            <label for="medical_appointment_patientName" class="required">Nomes e Sobrenomes <samp>*</samp></label>
            <input type="text" id="medical_appointment_patientName" name="medical_appointment[patientName]" required="required" placeholder="nomes e sobrenomes" class="form-control" />
        </div>
        <div class="col-sm-4">
            <label for="medical_appointment_consultationDate" class="required">Data da consulta <samp>*</samp></label>                       
            <input size="16" type="text" id="medical_appointment_consultationDate" name="medical_appointment[consultationDate]" required="required" class="form-control input-medium date-picker" placeholder="data da consulta" value="" />
        </div> 
        <div class="col-sm-2">
            <label for="medical_appointment_consultationTime" class="required">Hora <samp>*</samp></label>
            <input type="text" id="medical_appointment_consultationTime" name="medical_appointment[consultationTime]" required="required" class="form-control timepicker timepicker-no-seconds" />                       
        </div>
    </div>
    <div class="row margin-bottom-15">
        <div class="col-sm-6">
            <label for="medical_appointment_phone" class="required">Telefone de Contato <samp>*</samp></label>
            <input type="text" id="medical_appointment_phone" name="medical_appointment[phone]" required="required" placeholder="telefone de contato" class="phone-field form-control" />            
        </div>
        <div class="col-sm-6">
            <label for="medical_appointment_email" class="required">E-mail de contato  <samp>*</samp></label>
            <input type="email" id="medical_appointment_email" name="medical_appointment[email]" required="required" placeholder="correio eletrônico" class="form-control" >
        </div>    
    </div>
    <div id="appointment_captcha"></div>
    <br>
    <!--div class="row margin-bottom-15">
        <div class="col-sm-4"></div>
        <div class="col-sm-4 captcha">
                        
        </div>   
        <div class="col-sm-4"></div>
    </div-->    
    <button type="submit" class="btn btn-custom"> Enviar </button>
    <form name="_token" method="post"><input type="hidden" id="medical_appointment__token" name="medical_appointment[_token]" value="Ds9KXNERwY3u3ymBK8K2H6UamnUiCl_CaGQpB0m5Umw" /></form>
</form>
<script src="/app/assets/plugins/jquery.mask.min.js" type="text/javascript"></script>
<script src="https://www.google.com/recaptcha/api.js?onload=onloadCallback&render=explicit" async defer></script><script type="text/javascript">
    ComponentsSelect2.initMedicalAppointmentModal();
    jQuery(document).ready(function() {        
        $('.date-picker').datepicker({ 
                format: 'yyyy-mm-d',           
                orientation: "left",
                startDate: new Date(),
                daysOfWeekDisabled: [0,6],
                autoclose: true
            });
        $('.timepicker-no-seconds').timepicker({
            autoclose: true,
            defaultTime: '08:00', 
            maxHours: 9,
            minuteStep: 5,
            showMeridian: false
        }).on('changeTime.timepicker', function(e) {
            if(e.time.hours < 8 || e.time.hours >= 18 ) {                
                Layout.showDialog('Notificação#Selecione um horário entre 8:00 e 18:00. Obrigado!');
                $('.timepicker-no-seconds').timepicker('setTime', '08:00');
            }
        });
        $('.phone-field').mask('000-000-000', {clearIfNotMatch: true});     
    }); 
</script>