<?php $__env->startSection('title'); ?> <?php if( ! empty($title)): ?> <?php echo e($title); ?> | <?php endif; ?> ##parent-placeholder-3c6de1b7dd91465d437ef415f94f36afc1fbc8a8## <?php $__env->stopSection(); ?>

<?php $__env->startSection('main'); ?>






<div class="row">
    <div class="send-msg">
        <div class="text-center" style="padding-bottom: 30px">
            <h2>Contact The Provider to Receive More Information</h2>
            <p>Please feel free to get in touch with us by filling in the form below.</p>
        </div>
            
            <form method='post' action='<?php echo e(route('send-to-provider')); ?>'>
                <?php echo csrf_field(); ?>
                <div class="row">
                    <div class="contact-form">
                        <div class="row">
                            <input type="text" class="form-control" name="id" value="<?php echo e($provider->id); ?>" hidden readonly style='display:none;'/>
                            <div class="col-md-6 form-group contacts<?php echo e($errors->has('name')? 'has-error':''); ?> ">
                                <?php echo e(Form::label('fname','First Name*',['class'=>'control-label'])); ?>

                                <i class="fa fa-user con-icon"></i>
                                <input type="text" class="form-control" id="name" name="name" placeholder="First name" value="<?php echo e(old('name')); ?>" required="required" />
                                <?php echo $errors->has('name')? '<p class="help-block">'.$errors->first('name').'</p>':''; ?>

                            </div>
                            <div class="col-md-6 form-group contacts <?php echo e($errors->has('name')? 'has-error':''); ?> ">
                                <?php echo e(Form::label('lname','Last Name*',['class'=>'control-label'])); ?>

                                <i class="fa fa-user con-icon"></i>
                                <input type="text" class="form-control" id="name" name="lname" placeholder="Last name" value="<?php echo e(old('name')); ?>" required="required" />
                                <?php echo $errors->has('name')? '<p class="help-block">'.$errors->first('name').'</p>':''; ?>

                            </div>
                        </div>
                        <div class="row">
                            <div class="col-md-6 form-group contacts <?php echo e($errors->has('email')? 'has-error':''); ?>">
                                <?php echo e(Form::label('email','Email*',['class'=>'control-label'])); ?>

                                <i class="fas fa-envelope con-icon"></i>
                                    <input type="email" class="form-control" id="email" placeholder="Enter email" name="email" value="<?php echo e(old('email')); ?>" required="required" />
                                <?php echo $errors->has('email')? '<p class="help-block">'.$errors->first('email').'</p>':''; ?>


                            </div>
                            <div class="col-md-6 form-group contacts <?php echo e($errors->has('name')? 'has-error':''); ?> ">
                                <?php echo e(Form::label('phone','Phone',['class'=>'control-label'])); ?>

                                <i class="fa fa-phone con-icon"></i>
                                <input type="text" class="form-control" id="name" name="phone" placeholder="Enter phone" value="<?php echo e(old('phone')); ?>" />
                                <?php echo $errors->has('phone')? '<p class="help-block">'.$errors->first('phone').'</p>':''; ?>

                            </div>
                        </div>
                        <div class="form-group contacts <?php echo e($errors->has('message')? 'has-error':''); ?>">
                            <?php echo e(Form::label('message','Message*',['class'=>'control-label'])); ?>

                            
                            <textarea name="message" id="message" class="form-control" required style="height: 150px;"></textarea>
                            <?php echo $errors->has('message')? '<p class="help-block">'.$errors->first('message').'</p>':''; ?>

                        </div>
                        <div class="row text-center">
                            <button type="submit" class="btn btn-lg btn-learn"><strong><?php echo app('translator')->getFromJson('app.send_message'); ?></strong></button>
                        </div>
                    </div>
                </div>
            </form>
            </div>
        </div>



<?php $__env->stopSection(); ?>

<?php $__env->startSection('page-js'); ?>


    <script>
        <?php if(session('success')): ?>
            toastr.success('<?php echo e(session('success')); ?>', '<?php echo trans('app.success') ?>', toastr_options);
        <?php endif; ?>
    </script>
<?php $__env->stopSection(); ?>
<?php echo $__env->make('layout.main', \Illuminate\Support\Arr::except(get_defined_vars(), array('__data', '__path')))->render(); ?>