@extends('layouts/main-layout')


@section('meta_title')
Kidney Transplantation in Bangalore,India | Renal Doctors | Nephrologist
@endsection



@section('meta_description')
Kidney transplantation is the treatment of choice for a minority of patients. Read more about the process and details of
renal transplant surgery and how they may affect your body.
@endsection



@section('meta_keywords')
@endsection


@section('canonical')
https://www.nuhospitals.com/
@endsection



@section('custom-css')
<link rel="stylesheet" href="//code.jquery.com/ui/1.12.1/themes/base/jquery-ui.css">
<style>
h2 {
    font-size: 26px;
}

table {
    margin: 15px 0;
}

table td {
    padding: 5px;
    text-align: center;
}
</style>
@endsection



@section('content')
<section>
    <div class="container-fluid">
        <div class="row">
            <div class="col-md-12 p-0">
                <img class="img-responsive" src="{{asset('assets/images/banner/Web-banner Covid vaccination.jpg')}}"
                    alt="">
            </div>
        </div>
    </div>
</section>
<section>
    <div class="container-fluid">
        <div class="row justify-content-center">
            <div class="col-md-10 pt-5 pb-5">
                <div class="row">
                    <div class="col-md-6">
                        <h4>Covid Vaccination Registartion</h4>

                        <div class="content mt-3">
                            <!-- <h5>Vaccination Helpline:</h5> -->
                            <h5><a target="_blank"
                                    href="{{url('assets/docs/user-guide-citizen-registration.pdf')}}">User Manual -
                                    Citizen Registration and Appointment for Vaccination</a></h5>
                        </div>
                        <p><b>Covid Vaccination Registrations are open from 1st March-2021</b></p>

                        <p>Kindly convey below message to your parents and other senior citizen members.</p>

                        <p>How to register for COVID Vaccine for senior citizen</p>

                        <ul class="list-style-three">
                            <li>Use Co-Win app, <a href="https://www.aarogyasetu.gov.in/"><b>Aarogya Setu App
                                    </b></a> or log on to <a
                                    href="https://www.cowin.gov.in/home"><b>cowin.gov.in</b></a>
                            </li>
                            <li>Enter your mobile number</li>
                            <li>Get an OTP to create your account</li>
                            <li>Fill in your name, age, gender and upload an identity document</li>
                            <!-- <li>If 45+, upload doctor’s certificate as comorbidity proof</li> -->
                            <li>Choose centre, date</li>
                            <li>
                                <table border="1" cellspacing="0" cellpadding="0">
                                    <tbody>
                                        <tr>
                                            <td>&nbsp;</td>
                                            <td>Option 1</td>
                                            <td>Option 2</td>
                                        </tr>
                                        <tr>
                                            <td>Hospital</td>
                                            <td>NU Hospitals1</td>
                                            <td>NU Hospitals&nbsp;&nbsp;</td>
                                        </tr>
                                        <tr>
                                            <td>Location</td>
                                            <td>Rajajinagar</td>
                                            <td>Padmanabhanagar</td>
                                        </tr>
                                        <tr>
                                            <td>Pincode</td>
                                            <td>560010</td>
                                            <td>560070</td>
                                        </tr>
                                    </tbody>
                                </table>
                            </li>
                            <li>Up to 4 appointments can be made by one mobile number</li>
                        </ul>

                        <p>STAY SAFE and Stay Healthy</p>
                        <!-- <p>Click Here to Read: <a href="#">Vaccination Drive - What People Say</a> -->
                        </p>
                        <!-- <video width="100%" height="400" class="mt-3" controls autoplay>
                            <source src="{{asset('assets/images/covid-vaccine-steps.mp4')}}" type="video/mp4">
                            Your browser does not support the video tag.
                        </video> -->
                    </div>
                    <div class="col-md-6">
                        <h4>Pre Registration For Covid-19 Vaccination</h4>
                        <div class="row justify-content-center">
                            <div class="col-md-11 p-0 mt-3">
                                <form class="form-wrap" action='/covid-vaccine-request-submit.php' method='post'
                                    name='BookAppointmentFrm' id='BookAppointmentFrm'>
                                    <div class="row">
                                        <div class="col-md-6">
                                            <div class="form-group">
                                                <label for="registration-date">Registration Date</label>
                                                <input type="text" name="registration-date" class="form-control"
                                                    id="registration-date" placeholder="Registration Date"
                                                    autocomplete="off" required readonly>
                                            </div>
                                        </div>
                                        <div class="col-md-6">
                                            <div class="form-group">
                                                <label for="booking-date">Booking Vaccine Date</label>
                                                <input type="text" name="booking-date" class="form-control"
                                                    id="booking-date" placeholder="Booking Vaccine Date"
                                                    autocomplete="off" required readonly>
                                            </div>
                                        </div>


                                        <div class="col-md-6">
                                            <div class="form-group">
                                                <label for="fullname">Full Name</label>
                                                <input type="text" name="name" id="fullname" class="form-control"
                                                    placeholder="Full Name" required>
                                            </div>
                                        </div>
                                        <div class="col-md-6">
                                            <div class="form-group">
                                                <label for="dob">Date of Birth</label>
                                                <input type="text" name="dob" class="form-control" id="dob"
                                                    placeholder="Date of Birth" autocomplete="off" required readonly>
                                            </div>
                                        </div>
                                        <div class="col-md-6">
                                            <div class="form-group">
                                                <label for="age">Age</label>
                                                <input type="text" name="age" id="age" class="form-control"
                                                    placeholder="Age" required>
                                            </div>
                                        </div>
                                        <div class="col-md-6">
                                            <div class="form-group">
                                                <label for="age">Gender</label>
                                                <select name="gender" class="form-control" id="gender">
                                                    <option value="">Select Gender</option>
                                                    <option value="Male">Male</option>
                                                    <option value="Female">Female</option>
                                                </select>
                                            </div>
                                        </div>
                                        <div class="col-md-6">
                                            <div class="form-group">
                                                <label for="email">Email</label>
                                                <input type="email" id="email" name="email" class="form-control"
                                                    placeholder="Email" required>
                                            </div>
                                        </div>
                                        <div class="col-md-6">
                                            <div class="form-group">
                                                <label for="phone">Phone</label>
                                                <input type="text" id="phone" name="phone" class="form-control"
                                                    placeholder="Phone" required>
                                            </div>
                                        </div>
                                        <div class="col-md-12">
                                            <div class="form-group">
                                                <label for="identity-num">Aadhar No / Voter ID No / licence No / PAN
                                                    No</label>
                                                <input type="text" id="identity-num" name="identity-num"
                                                    class="form-control"
                                                    placeholder="Aadhar No / Voter ID No / licence No / PAN No"
                                                    required>
                                            </div>
                                        </div>
                                        <div class="col-md-12">
                                            <div class="form-group">
                                                <label for="address">Address</label>
                                                <textarea class="form-control" name="address" id="address" cols="30"
                                                    rows="5"></textarea>
                                            </div>
                                        </div>
                                        <div class="col-md-6">
                                            <div class="form-group">
                                                <label for="pincode">Pincode</label>
                                                <input type="text" name="pincode" class="form-control"
                                                    placeholder="Pincode" required>
                                            </div>
                                        </div>
                                        <div class="col-md-6">

                                        </div>
                                        <input type="text" style="display:none;" name="bot_source" id='bot_source'>

                                        <div class="col-md-6" id="submit-btn-wrap">
                                            <div class="col-md-8 p-0">
                                                <div class="form-group">
                                                    <input type="submit" id="submit-btn" class="bgclr-1 w-100 p-3"
                                                        value="Submit">
                                                </div>
                                            </div>
                                        </div>
                                    </div>
                                </form>
                            </div>
                        </div>
                    </div>
                </div>
            </div>
        </div>
    </div>
</section>
@endsection



@section('custom-js')
<script src="https://cdnjs.cloudflare.com/ajax/libs/jquery-validate/1.19.0/jquery.validate.min.js"></script>
<script src="https://code.jquery.com/ui/1.12.1/jquery-ui.js"></script>
<script>
function validateNumber(event) {
    var key = window.event ? event.keyCode : event.which;
    if (event.keyCode === 8 || event.keyCode === 46) {
        return true;
    } else if (key < 48 || key > 57) {
        return false;
    } else {
        return true;
    }
};
$(document).ready(function() {
    $('[name="phone"]').keypress(validateNumber);
});

$('[name="name"]').keypress(function(e) {
    var regex = new RegExp("^[a-zA-Z ]+$");
    var strigChar = String.fromCharCode(!e.charCode ? e.which : e.charCode);
    if (regex.test(strigChar)) {
        return true;
    }
    return false
});

$(document).ready(function() {
    $("#BookAppointmentFrm").validate({
        rules: {
            email: {
                required: true,
                email: true
            },
        }
    });
});

$("#registration-date").datepicker({
    formate: 'dd/mm/yy',
    dateFormat: 'dd/mm/yy',
    altFormat: "dd/mm/yy",
    altField: "#formatted_date"
});

$("#booking-date").datepicker({
    formate: 'dd/mm/yy',
    dateFormat: 'dd/mm/yy',
    altFormat: "dd/mm/yy",
    minDate: "+1",
    maxDate: new Date("30/11/2021"),
    altField: "#formatted_date"
});

$("#dob").datepicker({
    changeMonth: true,
    changeYear: true,
    yearRange: "-90:+00",
    formate: 'dd/mm/yy',
    dateFormat: 'dd/mm/yy',
    altFormat: "dd/mm/yy",
    altField: "#formatted_date"
});
</script>
@endsection