@extends('FrontEndLayouts.frontApp')
@include('FrontEndLayouts.globalJqueryAjaxFunction')
@section('content')
    <!-- Breadcrumb Area -->
    <section class="breadcrumb-area text-center">
        <div class="container">
            <div class="row">
                <div class="col-md-12">
                    <h2>Participate In Trial</h2>
                </div>
            </div>
        </div>
    </section>
    <!-- End Breadcrumb Area -->
    {{-- search section Start --}}
    <h5
        style="text-align:center; padding-top:30px; #dee2e6; color: black;margin-bottom: 10px;padding-left: 2px;font-weight: 900;ext-transform: uppercase;">
        Participate In a Clinical Research Study</h5>
    <!-- Contact Area -->
    <section class="contact-two">
        <div class="container">
            <div class="row">
                <div class="col-lg-6 col-md-12">
                    <div class="contact-form">
                        <h5 style="margin-top: -31px;">Sign Up Below</h5>
                        <form id="ajax-contact" method="post"
                            action="http://www.thetahmid.com/themes/mediseba-v1.2/send.php">
                            <div class="row">
                                <div class="col-md-12">
                                    <p><input type="text" id="name" name="name" placeholder="Name" required=""></p>
                                </div>
                                {{-- <div class="col-md-12">
                                    <p><input type="text" id="name" name="name" placeholder="Last Name" required=""></p>
                                </div> --}}
                                <div class="col-md-12">
                                    <p><input type="text" id="email" name="email" placeholder="Email" required=""></p>
                                </div>
                                {{-- <div class="col-md-12">
                                    <p><input type="number" id="number" name="number" placeholder="Phone Number"></p>
                                </div> --}}
                                {{-- <div class="col-md-12">
                                    <p> <input type="date" id="datetimepicker" data-toggle="datetimepicker"
                                            data-target="#datetimepicker" name="appdate" placeholder="Birth Date"></p>
                                </div> --}}
                                <div class="col-md-12">
                                    <p>
                                        <textarea name="message" id="message" placeholder="Comments" required=""></textarea>
                                    </p>
                                </div>
                                <div class="col-md-12">
                                    <button type="submit">Submit </button>
                                </div>
                            </div>
                            <div id="form-messages"></div>
                        </form>
                    </div>
                </div>

                <div class="col-md-6">
                    <div class="about-image">
                        <img src="{{ URL::asset('frontEndAssets/images/Contact.JPG') }}" alt="" class="img-fluid">
                    </div>
                </div>
            </div>
        </div>
    </section>
@endsection