@extends('layouts.base')

@section('title', 'Pharmacy Registration')

@section('content')
    <div class="row justify-content-center">
        <div class="col-lg-8">
            <div class="card shadow-sm">
                <div class="card-body p-4">
                    <h1 class="h4 mb-3">Register Pharmacy</h1>

                    <form method="POST" action="{{ route('register.submit') }}">
                        @csrf

                        <div class="row g-3">
                            <div class="col-md-6">
                                <label class="form-label">Owner Name</label>
                                <input type="text" name="name" class="form-control" value="{{ old('name') }}" required>
                            </div>
                            <div class="col-md-6">
                                <label class="form-label">Owner Email</label>
                                <input type="email" name="email" class="form-control" value="{{ old('email') }}" required>
                            </div>
                            <div class="col-md-6">
                                <label class="form-label">Password</label>
                                <input type="password" name="password" class="form-control" required>
                            </div>
                            <div class="col-md-6">
                                <label class="form-label">Confirm Password</label>
                                <input type="password" name="password_confirmation" class="form-control" required>
                            </div>

                            <div class="col-md-8">
                                <label class="form-label">Pharmacy Name</label>
                                <input type="text" name="pharmacy_name" class="form-control" value="{{ old('pharmacy_name') }}" required>
                            </div>
                            <div class="col-md-4">
                                <label class="form-label">License Number</label>
                                <input type="text" name="license_number" class="form-control" value="{{ old('license_number') }}" required>
                            </div>
                            <div class="col-md-6">
                                <label class="form-label">Phone</label>
                                <input type="text" name="contact_phone" class="form-control" value="{{ old('contact_phone') }}">
                            </div>
                            <div class="col-md-6">
                                <label class="form-label">Contact Email</label>
                                <input type="email" name="contact_email" class="form-control" value="{{ old('contact_email') }}">
                            </div>
                            <div class="col-12">
                                <label class="form-label">Address</label>
                                <input type="text" name="address_line" class="form-control" value="{{ old('address_line') }}">
                            </div>
                            <div class="col-md-4">
                                <label class="form-label">City</label>
                                <input type="text" name="city" class="form-control" value="{{ old('city') }}">
                            </div>
                            <div class="col-md-4">
                                <label class="form-label">State</label>
                                <input type="text" name="state" class="form-control" value="{{ old('state') }}">
                            </div>
                            <div class="col-md-4">
                                <label class="form-label">Country</label>
                                <input type="text" name="country" class="form-control" value="{{ old('country') }}">
                            </div>
                        </div>

                        <div class="mt-4 d-flex gap-2">
                            <button type="submit" class="btn btn-primary">Submit for Verification</button>
                            <a class="btn btn-outline-secondary" href="{{ route('login') }}">Back to Login</a>
                        </div>

                        <div class="mt-3 text-muted small">
                            This platform is private. Your pharmacy must be verified by admin before using the marketplace.
                        </div>
                    </form>
                </div>
            </div>
        </div>
    </div>
@endsection