144 lines
7.9 KiB
Twig
144 lines
7.9 KiB
Twig
{% extends template ~ '.html.twig' %}
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{% block title %}Регистрация пациента{% endblock %}
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{% block js %}
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{% if 'sova.local' not in app.request.host %}
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<script id="smartCaptcha" src="https://smartcaptcha.yandexcloud.net/captcha.js"></script>
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{% endif %}
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{% endblock %}
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{% block top %}
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<div class="top-section">
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<h1 class="title" id="page-title">{{ title }}</h1>
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</div>
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{% endblock %}
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{% block body %}
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<div data-controller="registration" id="register" class="form">
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<div class="alert filter msg" role="alert">
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Поля, обозначенные звездочкой (<span class="text-danger">*</span>), обязательны для заполнения
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</div>
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<div class="register-start">
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<div class="form-group row">
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<label for="phone" class="col-sm-3 col-form-label">Телефон<span class="text-danger">*</span></label>
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<div class="col-sm-9">
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<input type="text" class="form-control" id="phone" data-controller="inputMask">
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<div class="msg-valid valid-phone"></div>
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</div>
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</div>
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<div class="form-group row">
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<div class="col-md-5 d-capcha-start"></div>
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<div class="col-md-7 license"></div>
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</div>
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<button class="btn btn-outline-secondary submit-filter filter__btn submit-filter" data-action="registration#btnStart">Далее</button>
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</div>
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<div class="register-init d-none">
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<div class="form-group row">
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<label for="lastName" class="col-sm-3 col-form-label">Фамилия<span class="text-danger">*</span></label>
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<div class="col-sm-9">
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<input type="text" class="form-control" id="lastName">
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<div class="msg-valid valid-lastName"></div>
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</div>
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</div>
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<div class="form-group row">
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<label for="firstName" class="col-sm-3 col-form-label">Имя<span class="text-danger">*</span></label>
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<div class="col-sm-9">
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<input type="text" class="form-control" id="firstName">
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<div class="msg-valid valid-firstName"></div>
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</div>
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</div>
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<div class="form-group row">
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<label for="middleName" class="col-sm-3 col-form-label">Отчество<span class="text-danger">*</span></label>
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<div class="col-sm-9">
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<input type="text" class="form-control" id="middleName">
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<div class="msg-valid valid-middleName"></div>
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</div>
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</div>
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<div class="form-group row">
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<label for="staticEmail" class="col-sm-3 col-form-label">Email<span class="text-danger">*</span></label>
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<div class="col-sm-9">
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<input type="email" class="form-control" id="email">
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<div class="msg-valid valid-email">указывайте действующий e-mail, к которому привязан ваш аккаунт <br> на сайте Госуслуги</div>
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</div>
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</div>
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<div class="form-group row">
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<label for="birthDate" class="col-sm-3 col-form-label">Дата рождения<span class="text-danger">*</span></label>
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<div class="col-sm-9">
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<input type="text" class="form-control" id="birthDate" data-controller = 'datePicker' range = 'false'>
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<div class="msg-valid valid-birthDate"></div>
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</div>
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</div>
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<div class="form-group row">
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<label class="col-sm-3 col-form-label">Пол<span class="text-danger">*</span></label>
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<div class="col-sm-9">
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<div class="form-check form-check-inline">
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<input class="form-check-input gender" type="radio" name="gender" id="gender_0" value="1">
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<label class="form-check-label" for="gender_0">
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Мужской
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</label>
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</div>
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<div class="form-check form-check-inline">
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<input class="form-check-input gender" type="radio" name="gender" id="gender_1" value="2">
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<label class="form-check-label" for="gender_1">
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Женский
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</label>
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</div>
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<div class="msg-valid valid-gender"></div>
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</div>
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</div>
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<div class="form-group row">
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<div class="col-md-5 d-capcha-init"></div>
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<div class="col-md-7 license"></div>
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</div>
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<button class="btn btn-back button d-inline" data-action="registration#btnBack">Назад</button>
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<button class="btn btn-outline-secondary submit-filter filter__btn submit-filter d-inline" data-action="registration#btnReg">Регистрация</button>
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</div>
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<div class="register-complete d-none" data-r-token="null" data-pwd-token="null" data-type="null">
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<div class="form-group row smsCode d-none">
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<div class="col-12">
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<div class="alert alertSmsCode filter" role="alert">
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На номер телефона <span class="smsView"></span> был выслан код подтверждения. Введите его в поле "Код из SMS" и нажмите "Подтвердить" <br>
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Введите пароль, который вы хотите использовать для входа в свой личный кабинет на сайте
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</div>
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</div>
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<label for="smsCode" class="col-sm-2 col-form-label">Код из SMS<span class="text-danger">*</span></label>
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<div class="col-sm-9">
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<input type="text" class="form-control" id="smsCode">
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<div class="msg-valid valid-smsCode"></div>
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</div>
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</div>
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<div class="form-group row emailCode d-none">
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<div class="col-12">
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<div class="alert alertEmailView filter" role="alert">
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На адрес <span class="emailView"></span> был выслан код подтверждения. Введите его в поле "Код из почты" и нажмите "Подтвердить" <br>
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Введите пароль, который вы хотите использовать для входа в свой личный кабинет на сайте
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</div>
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</div>
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<label for="emailCode" class="col-md-4 col-form-label">Код из почты<span class="text-danger">*</span></label>
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<div class="col-md-8">
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<input type="text" class="form-control" id="emailCode">
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<div class="msg-valid valid-emailCode"></div>
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</div>
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</div>
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<div class="form-group row">
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<label for="password" class="col-md-4 col-form-label">Придумайте пароль<span class="text-danger">*</span></label>
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<div class="col-sm-8">
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<input type="password" class="form-control" id="password">
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<div class="msg-valid valid-confirm valid-password">не менее 7 символов</div>
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</div>
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</div>
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<div class="license"></div>
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<button class="btn btn-back button d-inline" data-action="registration#btnBack">Назад</button>
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<button class="btn button d-inline" data-action="registration#btnComplite">Подтвердить</button>
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</div>
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</div>
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{% endblock %}
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