@php
    $states = [
        "AL" => "Alabama",
        "AK" => "Alaska",
        "AZ" => "Arizona",
        "AR" => "Arkansas",
        "CA" => "California",
        "CO" => "Colorado",
        "CT" => "Connecticut",
        "DE" => "Delaware",
        "DC" => "District of Columbia",
        "FL" => "Florida",
        "GA" => "Georgia",
        "HI" => "Hawaii",
        "ID" => "Idaho",
        "IL" => "Illinois",
        "IN" => "Indiana",
        "IA" => "Iowa",
        "KS" => "Kansas",
        "KY" => "Kentucky",
        "LA" => "Louisiana",
        "ME" => "Maine",
        "MD" => "Maryland",
        "MA" => "Massachusetts",
        "MI" => "Michigan",
        "MN" => "Minnesota",
        "MS" => "Mississippi",
        "MO" => "Missouri",
        "MT" => "Montana",
        "NE" => "Nebraska",
        "NV" => "Nevada",
        "NH" => "New Hampshire",
        "NJ" => "New Jersey",
        "NM" => "New Mexico",
        "NY" => "New York",
        "NC" => "North Carolina",
        "ND" => "North Dakota",
        "OH" => "Ohio",
        "OK" => "Oklahoma",
        "OR" => "Oregon",
        "PA" => "Pennsylvania",
        "RI" => "Rhode Island",
        "SC" => "South Carolina",
        "SD" => "South Dakota",
        "TN" => "Tennessee",
        "TX" => "Texas",
        "UT" => "Utah",
        "VT" => "Vermont",
        "VA" => "Virginia",
        "WA" => "Washington",
        "WV" => "West Virginia",
        "WI" => "Wisconsin",
        "WY" => "Wyoming"
    ];
    $consultationTypes = [
        "Telemedicine",
        "In-person",
        "Emergency",
        "Specialty"
    ];

    /**
    $test = [
        'email' => 'test1@test.com',
        'password' => 'password',
        'password_confirmation' => 'password',
        'fname' => 'fname',
        'lname' => 'lname',
        'gender' => 'M',
        'dob' => '1980-01-01',
        'address1' => 'add1',
        'address2' => 'add2',
        'city' => 'city',
        'state' => 'AL',
        'zip' => '12345',
        'bio' => 'bio',
        'phone' => '1234',
        'mobile_phone' => '123',
        'primary_license_state' => 'AL',
        'primary_license_number' => 'primary_license_number',
        'dea_number' => 'dea_number',
        'licensed_states' => ['AK', 'HI'],
        'availability' => 'Full-time',
        'hourly_rate' => 60,
        'lowest_consult_rate' => 15,
        'consultation_types' => ['In-person'],
    ];
    */ 
@endphp
<x-guest-layout>
    <x-cards.signup>
        <x-splade-form :action="route('doctors.store')" class="max-w-2xl mx-auto mt-8">
            <div class="space-y-6">
                <h2 class="text-2xl font-semibold">Doctor Registration</h2>

                <x-splade-input name="email" label="Email Address" type="email" required />
                <x-splade-input name="password" label="Password" type="password" required />
                <x-splade-input name="password_confirmation" label="Confirm Password" type="password" required />
                <x-splade-input name="fname" label="First Name" required />
                <x-splade-input name="lname" label="Last Name" required />
                <x-splade-select name="gender" label="Gender" :options="['M' => 'Male', 'F' => 'Female', 'O' => 'Other']" required />
                <x-splade-input name="dob" label="Date of Birth" type="date" required />
                <x-splade-input name="address1" label="Address Line 1" required />
                <x-splade-input name="address2" label="Address Line 2" />
                <x-splade-input name="city" label="City" required />
                <x-splade-select name="state" label="State" :options="$states" required choices />
                <x-splade-input name="zip" label="Zip Code" required />
                <x-splade-textarea name="bio" label="Bio" />
                <x-splade-file name="image" label="Profile Image" />
                <x-splade-input name="phone" label="Phone Number" required />
                <x-splade-input name="mobile_phone" label="Mobile Phone" />

                <x-specialty-selector />

                <x-splade-select name="primary_license_state" label="Primary State Licensed In" :options="$states" required choices />
                <x-splade-input name="primary_license_number" label="Primary State Medical License Number" required />
                <x-splade-input name="dea_number" label="DEA Number" required />
                <x-splade-select name="licensed_states" label="List all states you are currently licensed in" :options="$states" required multiple choices />

                <x-splade-select name="availability" label="Availability" :options="['Full-time', 'Part-time', 'Weekends']" required />

                <x-splade-input name="hourly_rate" type="number" min="60" label="Hourly Rate (minimum $60)" required />
                <x-splade-input name="lowest_consult_rate" type="number" min="15" label="Lowest Rate You Can Offer Per Consult (minimum $15)" required />

                <x-splade-select name="consultation_types" label="Types of Consultations Willing to Work On" :options="$consultationTypes" required multiple choices />

                <x-availability-selector />

                <x-splade-checkbox name="interstate_license_registered" label="Have you registered for interstate Medical Licensure?" />

                <x-splade-submit class="w-full">Sign Up</x-splade-submit>
            </div>
        </x-splade-form>
    </x-cards.signup>
</x-guest-layout>