
<?php if (isset($component)) { $__componentOriginalf2a1b2b34b0a376d40858ac9c2a946a5 = $component; } ?>
<?php if (isset($attributes)) { $__attributesOriginalf2a1b2b34b0a376d40858ac9c2a946a5 = $attributes; } ?>
<?php $component = App\View\Components\SiteLayout::resolve(['title' => 'Register Your Health Institution','metaDescription' => 'Register your healthcare facility on our directory and reach patients across South Sudan.'] + (isset($attributes) && $attributes instanceof Illuminate\View\ComponentAttributeBag ? $attributes->all() : [])); ?>
<?php $component->withName('site-layout'); ?>
<?php if ($component->shouldRender()): ?>
<?php $__env->startComponent($component->resolveView(), $component->data()); ?>
<?php if (isset($attributes) && $attributes instanceof Illuminate\View\ComponentAttributeBag): ?>
<?php $attributes = $attributes->except(\App\View\Components\SiteLayout::ignoredParameterNames()); ?>
<?php endif; ?>
<?php $component->withAttributes([]); ?>
    
    <section class="bg-gradient-to-r from-green-600 to-green-700 text-white py-12">
        <div class="max-w-7xl mx-auto px-4 sm:px-6 lg:px-8">
            <div class="text-center">
                <h1 class="text-3xl md:text-4xl font-bold mb-3">
                    <i class="fas fa-hospital mr-3"></i>Register Your Health Institution
                </h1>
                <p class="text-green-100 text-lg max-w-2xl mx-auto">
                    Join our growing directory of healthcare facilities across South Sudan. 
                    Connect with patients and grow your practice.
                </p>
            </div>
        </div>
    </section>
    
    
    <div class="bg-gray-50 border-b border-gray-200">
        <div class="max-w-7xl mx-auto px-4 sm:px-6 lg:px-8 py-3">
            <nav class="flex items-center space-x-2 text-sm text-gray-600" aria-label="Breadcrumb">
                <a href="<?php echo e(url('/')); ?>" class="hover:text-green-600 transition flex items-center">
                    <i class="fas fa-home mr-1"></i>Home
                </a>
                <i class="fas fa-chevron-right text-gray-400 text-xs"></i>
                <a href="<?php echo e(route('institutions.index')); ?>" class="hover:text-green-600 transition">Health Institutions</a>
                <i class="fas fa-chevron-right text-gray-400 text-xs"></i>
                <span class="text-gray-900 font-medium">Register Your Institution</span>
            </nav>
        </div>
    </div>

    
    <section class="py-12 bg-gray-50">
        <div class="max-w-4xl mx-auto px-4 sm:px-6 lg:px-8">
            
            
            <?php if($requiresPayment): ?>
                <div class="mb-6 bg-blue-50 border-l-4 border-blue-500 p-4 rounded-r-lg">
                    <div class="flex items-start">
                        <i class="fas fa-info-circle text-blue-500 mt-0.5 mr-3"></i>
                        <div>
                            <h4 class="font-semibold text-blue-800">Listing Fee Required</h4>
                            <p class="text-blue-700 text-sm">
                                After registration, a payment of 
                                <strong>SSP <?php echo e(number_format($paymentConfig->amount_ssp)); ?></strong>
                                <?php if($paymentConfig->amount_usd): ?>
                                    (or <strong>USD <?php echo e(number_format($paymentConfig->amount_usd)); ?></strong>)
                                <?php endif; ?>
                                is required to publish your listing.
                            </p>
                        </div>
                    </div>
                </div>
            <?php endif; ?>
            
            
            <form action="<?php echo e(route('institutions.register.store')); ?>" method="POST" enctype="multipart/form-data"
                  x-data="{
                      step: 1,
                      totalSteps: 3,
                      formData: {
                          name: '',
                          short_name: '',
                          city: '',
                          address: '',
                          country: 'South Sudan',
                          email: '',
                          phone: '',
                          website_url: '',
                          description: '',
                          services: [],
                          contact_name: '',
                          contact_email: '',
                          contact_phone: '',
                      },
                      nextStep() {
                          if (this.step < this.totalSteps) this.step++;
                      },
                      prevStep() {
                          if (this.step > 1) this.step--;
                      }
                  }">
                <?php echo csrf_field(); ?>
                
                
                <div class="mb-8">
                    <div class="flex items-center justify-between mb-2">
                        <span class="text-sm font-medium text-gray-700">Step <span x-text="step"></span> of <span x-text="totalSteps"></span></span>
                        <span class="text-sm text-green-600 font-medium" x-text="Math.round((step / totalSteps) * 100) + '% Complete'"></span>
                    </div>
                    <div class="w-full bg-gray-200 rounded-full h-3">
                        <div class="bg-gradient-to-r from-green-600 to-green-700 h-3 rounded-full transition-all duration-300"
                             :style="'width: ' + (step / totalSteps) * 100 + '%'"></div>
                    </div>
                </div>
                
                
                <div x-show="step === 1" x-transition class="bg-white rounded-xl shadow-md p-6 lg:p-8">
                    <fieldset>
                        <legend class="text-xl font-bold text-gray-800 mb-6 pb-4 border-b">
                            <i class="fas fa-building text-green-500 mr-2"></i>Institution Details
                        </legend>
                        
                        <div class="grid grid-cols-1 md:grid-cols-2 gap-6">
                            
                            <div class="md:col-span-2">
                                <label class="block text-sm font-medium text-gray-700 mb-2">
                                    Institution Name <span class="text-red-500">*</span>
                                </label>
                                <input type="text" name="name" required
                                       class="w-full px-4 py-3 border-2 border-gray-200 rounded-lg focus:border-green-500 focus:ring-4 focus:ring-green-100 transition"
                                       placeholder="e.g., Juba Teaching Hospital"
                                       x-model="formData.name">
                                <?php $__errorArgs = ['name'];
$__bag = $errors->getBag($__errorArgs[1] ?? 'default');
if ($__bag->has($__errorArgs[0])) :
if (isset($message)) { $__messageOriginal = $message; }
$message = $__bag->first($__errorArgs[0]); ?>
                                    <p class="mt-1 text-sm text-red-600"><?php echo e($message); ?></p>
                                <?php unset($message);
if (isset($__messageOriginal)) { $message = $__messageOriginal; }
endif;
unset($__errorArgs, $__bag); ?>
                            </div>
                            
                            
                            <div>
                                <label class="block text-sm font-medium text-gray-700 mb-2">
                                    Short Name <span class="text-gray-400">(Optional)</span>
                                </label>
                                <input type="text" name="short_name"
                                       class="w-full px-4 py-3 border-2 border-gray-200 rounded-lg focus:border-green-500 transition"
                                       placeholder="e.g., JTH"
                                       x-model="formData.short_name">
                            </div>
                            
                            
                            <div>
                                <label class="block text-sm font-medium text-gray-700 mb-2">
                                    Logo <span class="text-gray-400">(Optional)</span>
                                </label>
                                <input type="file" name="logo" accept="image/*"
                                       class="w-full px-4 py-2 border-2 border-gray-200 rounded-lg focus:border-green-500 transition">
                                <p class="mt-1 text-xs text-gray-500">Max 2MB. JPG, PNG, WEBP</p>
                            </div>
                            
                            
                            <div>
                                <label class="block text-sm font-medium text-gray-700 mb-2">
                                    City <span class="text-red-500">*</span>
                                </label>
                                <select name="city" required
                                        class="w-full px-4 py-3 border-2 border-gray-200 rounded-lg focus:border-green-500 transition"
                                        x-model="formData.city">
                                    <option value="">Select City</option>
                                    <?php $__currentLoopData = $cities; $__env->addLoop($__currentLoopData); foreach($__currentLoopData as $city): $__env->incrementLoopIndices(); $loop = $__env->getLastLoop(); ?>
                                        <option value="<?php echo e($city); ?>"><?php echo e($city); ?></option>
                                    <?php endforeach; $__env->popLoop(); $loop = $__env->getLastLoop(); ?>
                                </select>
                                <?php $__errorArgs = ['city'];
$__bag = $errors->getBag($__errorArgs[1] ?? 'default');
if ($__bag->has($__errorArgs[0])) :
if (isset($message)) { $__messageOriginal = $message; }
$message = $__bag->first($__errorArgs[0]); ?>
                                    <p class="mt-1 text-sm text-red-600"><?php echo e($message); ?></p>
                                <?php unset($message);
if (isset($__messageOriginal)) { $message = $__messageOriginal; }
endif;
unset($__errorArgs, $__bag); ?>
                            </div>
                            
                            
                            <div>
                                <label class="block text-sm font-medium text-gray-700 mb-2">
                                    Country <span class="text-red-500">*</span>
                                </label>
                                <select name="country" required
                                        class="w-full px-4 py-3 border-2 border-gray-200 rounded-lg focus:border-green-500 transition">
                                    <option value="South Sudan" selected>South Sudan</option>
                                    <option value="Uganda">Uganda</option>
                                    <option value="Kenya">Kenya</option>
                                    <option value="Sudan">Sudan</option>
                                    <option value="Ethiopia">Ethiopia</option>
                                </select>
                            </div>
                            
                            
                            <div class="md:col-span-2">
                                <label class="block text-sm font-medium text-gray-700 mb-2">
                                    Full Address <span class="text-red-500">*</span>
                                </label>
                                <input type="text" name="address" required
                                       class="w-full px-4 py-3 border-2 border-gray-200 rounded-lg focus:border-green-500 transition"
                                       placeholder="Street address, area, landmark"
                                       x-model="formData.address">
                                <?php $__errorArgs = ['address'];
$__bag = $errors->getBag($__errorArgs[1] ?? 'default');
if ($__bag->has($__errorArgs[0])) :
if (isset($message)) { $__messageOriginal = $message; }
$message = $__bag->first($__errorArgs[0]); ?>
                                    <p class="mt-1 text-sm text-red-600"><?php echo e($message); ?></p>
                                <?php unset($message);
if (isset($__messageOriginal)) { $message = $__messageOriginal; }
endif;
unset($__errorArgs, $__bag); ?>
                            </div>
                        </div>
                    </fieldset>
                </div>
                
                
                <div x-show="step === 2" x-transition class="bg-white rounded-xl shadow-md p-6 lg:p-8">
                    <fieldset>
                        <legend class="text-xl font-bold text-gray-800 mb-6 pb-4 border-b">
                            <i class="fas fa-phone-alt text-green-500 mr-2"></i>Contact & Services
                        </legend>
                        
                        <div class="grid grid-cols-1 md:grid-cols-2 gap-6 mb-8">
                            
                            <div>
                                <label class="block text-sm font-medium text-gray-700 mb-2">
                                    Contact Email <span class="text-red-500">*</span>
                                </label>
                                <input type="email" name="email" required
                                       class="w-full px-4 py-3 border-2 border-gray-200 rounded-lg focus:border-green-500 transition"
                                       placeholder="info@hospital.org"
                                       x-model="formData.email">
                                <?php $__errorArgs = ['email'];
$__bag = $errors->getBag($__errorArgs[1] ?? 'default');
if ($__bag->has($__errorArgs[0])) :
if (isset($message)) { $__messageOriginal = $message; }
$message = $__bag->first($__errorArgs[0]); ?>
                                    <p class="mt-1 text-sm text-red-600"><?php echo e($message); ?></p>
                                <?php unset($message);
if (isset($__messageOriginal)) { $message = $__messageOriginal; }
endif;
unset($__errorArgs, $__bag); ?>
                            </div>
                            
                            
                            <div>
                                <label class="block text-sm font-medium text-gray-700 mb-2">
                                    Phone Number <span class="text-red-500">*</span>
                                </label>
                                <input type="tel" name="phone" required
                                       class="w-full px-4 py-3 border-2 border-gray-200 rounded-lg focus:border-green-500 transition"
                                       placeholder="+211 9XX XXX XXX"
                                       x-model="formData.phone">
                                <?php $__errorArgs = ['phone'];
$__bag = $errors->getBag($__errorArgs[1] ?? 'default');
if ($__bag->has($__errorArgs[0])) :
if (isset($message)) { $__messageOriginal = $message; }
$message = $__bag->first($__errorArgs[0]); ?>
                                    <p class="mt-1 text-sm text-red-600"><?php echo e($message); ?></p>
                                <?php unset($message);
if (isset($__messageOriginal)) { $message = $__messageOriginal; }
endif;
unset($__errorArgs, $__bag); ?>
                            </div>
                            
                            
                            <div class="md:col-span-2">
                                <label class="block text-sm font-medium text-gray-700 mb-2">
                                    Website <span class="text-gray-400">(Optional)</span>
                                </label>
                                <input type="url" name="website_url"
                                       class="w-full px-4 py-3 border-2 border-gray-200 rounded-lg focus:border-green-500 transition"
                                       placeholder="https://www.hospital.org"
                                       x-model="formData.website_url">
                            </div>
                            
                            
                            <div class="md:col-span-2">
                                <label class="block text-sm font-medium text-gray-700 mb-2">
                                    Description <span class="text-red-500">*</span>
                                </label>
                                <textarea name="description" rows="4" required
                                          class="w-full px-4 py-3 border-2 border-gray-200 rounded-lg focus:border-green-500 transition"
                                          placeholder="Describe your institution, its history, and what makes it unique..."
                                          x-model="formData.description"></textarea>
                                <p class="mt-1 text-xs text-gray-500">Minimum 50 characters</p>
                                <?php $__errorArgs = ['description'];
$__bag = $errors->getBag($__errorArgs[1] ?? 'default');
if ($__bag->has($__errorArgs[0])) :
if (isset($message)) { $__messageOriginal = $message; }
$message = $__bag->first($__errorArgs[0]); ?>
                                    <p class="mt-1 text-sm text-red-600"><?php echo e($message); ?></p>
                                <?php unset($message);
if (isset($__messageOriginal)) { $message = $__messageOriginal; }
endif;
unset($__errorArgs, $__bag); ?>
                            </div>
                        </div>
                        
                        
                        <div>
                            <label class="block text-sm font-medium text-gray-700 mb-3">
                                Services Offered <span class="text-red-500">*</span>
                            </label>
                            <div class="grid grid-cols-2 md:grid-cols-3 lg:grid-cols-4 gap-3">
                                <?php $__currentLoopData = $services; $__env->addLoop($__currentLoopData); foreach($__currentLoopData as $service): $__env->incrementLoopIndices(); $loop = $__env->getLastLoop(); ?>
                                    <label class="flex items-center bg-gray-50 rounded-lg p-3 cursor-pointer hover:bg-green-50 transition">
                                        <input type="checkbox" name="services[]" value="<?php echo e($service); ?>"
                                               class="w-4 h-4 text-green-600 border-gray-300 rounded focus:ring-green-500">
                                        <span class="ml-2 text-sm text-gray-700"><?php echo e($service); ?></span>
                                    </label>
                                <?php endforeach; $__env->popLoop(); $loop = $__env->getLastLoop(); ?>
                            </div>
                            <?php $__errorArgs = ['services'];
$__bag = $errors->getBag($__errorArgs[1] ?? 'default');
if ($__bag->has($__errorArgs[0])) :
if (isset($message)) { $__messageOriginal = $message; }
$message = $__bag->first($__errorArgs[0]); ?>
                                <p class="mt-2 text-sm text-red-600"><?php echo e($message); ?></p>
                            <?php unset($message);
if (isset($__messageOriginal)) { $message = $__messageOriginal; }
endif;
unset($__errorArgs, $__bag); ?>
                        </div>
                    </fieldset>
                </div>
                
                
                <div x-show="step === 3" x-transition class="bg-white rounded-xl shadow-md p-6 lg:p-8">
                    <fieldset>
                        <legend class="text-xl font-bold text-gray-800 mb-6 pb-4 border-b">
                            <i class="fas fa-user text-green-500 mr-2"></i>Create Your Account
                        </legend>
                        
                        <p class="text-gray-600 mb-6">
                            Create your Health Marketor account to manage your institution listing.
                        </p>
                        
                        <div class="grid grid-cols-1 md:grid-cols-2 gap-6">
                            
                            <div>
                                <label class="block text-sm font-medium text-gray-700 mb-2">
                                    Your Name <span class="text-red-500">*</span>
                                </label>
                                <input type="text" name="contact_name" required
                                       class="w-full px-4 py-3 border-2 border-gray-200 rounded-lg focus:border-green-500 transition"
                                       placeholder="John Doe"
                                       x-model="formData.contact_name">
                                <?php $__errorArgs = ['contact_name'];
$__bag = $errors->getBag($__errorArgs[1] ?? 'default');
if ($__bag->has($__errorArgs[0])) :
if (isset($message)) { $__messageOriginal = $message; }
$message = $__bag->first($__errorArgs[0]); ?>
                                    <p class="mt-1 text-sm text-red-600"><?php echo e($message); ?></p>
                                <?php unset($message);
if (isset($__messageOriginal)) { $message = $__messageOriginal; }
endif;
unset($__errorArgs, $__bag); ?>
                            </div>
                            
                            
                            <div>
                                <label class="block text-sm font-medium text-gray-700 mb-2">
                                    Your Email <span class="text-red-500">*</span>
                                </label>
                                <input type="email" name="contact_email" required
                                       class="w-full px-4 py-3 border-2 border-gray-200 rounded-lg focus:border-green-500 transition"
                                       placeholder="john@example.com"
                                       x-model="formData.contact_email">
                                <?php $__errorArgs = ['contact_email'];
$__bag = $errors->getBag($__errorArgs[1] ?? 'default');
if ($__bag->has($__errorArgs[0])) :
if (isset($message)) { $__messageOriginal = $message; }
$message = $__bag->first($__errorArgs[0]); ?>
                                    <p class="mt-1 text-sm text-red-600"><?php echo e($message); ?></p>
                                <?php unset($message);
if (isset($__messageOriginal)) { $message = $__messageOriginal; }
endif;
unset($__errorArgs, $__bag); ?>
                            </div>
                            
                            
                            <div>
                                <label class="block text-sm font-medium text-gray-700 mb-2">
                                    Your Phone <span class="text-red-500">*</span>
                                </label>
                                <input type="tel" name="contact_phone" required
                                       class="w-full px-4 py-3 border-2 border-gray-200 rounded-lg focus:border-green-500 transition"
                                       placeholder="+211 9XX XXX XXX"
                                       x-model="formData.contact_phone">
                                <?php $__errorArgs = ['contact_phone'];
$__bag = $errors->getBag($__errorArgs[1] ?? 'default');
if ($__bag->has($__errorArgs[0])) :
if (isset($message)) { $__messageOriginal = $message; }
$message = $__bag->first($__errorArgs[0]); ?>
                                    <p class="mt-1 text-sm text-red-600"><?php echo e($message); ?></p>
                                <?php unset($message);
if (isset($__messageOriginal)) { $message = $__messageOriginal; }
endif;
unset($__errorArgs, $__bag); ?>
                            </div>
                            
                            
                            <div>
                                <label class="block text-sm font-medium text-gray-700 mb-2">
                                    Password <span class="text-red-500">*</span>
                                </label>
                                <input type="password" name="contact_password" required
                                       class="w-full px-4 py-3 border-2 border-gray-200 rounded-lg focus:border-green-500 transition"
                                       placeholder="Min 8 characters">
                                <?php $__errorArgs = ['contact_password'];
$__bag = $errors->getBag($__errorArgs[1] ?? 'default');
if ($__bag->has($__errorArgs[0])) :
if (isset($message)) { $__messageOriginal = $message; }
$message = $__bag->first($__errorArgs[0]); ?>
                                    <p class="mt-1 text-sm text-red-600"><?php echo e($message); ?></p>
                                <?php unset($message);
if (isset($__messageOriginal)) { $message = $__messageOriginal; }
endif;
unset($__errorArgs, $__bag); ?>
                            </div>
                            
                            
                            <div>
                                <label class="block text-sm font-medium text-gray-700 mb-2">
                                    Confirm Password <span class="text-red-500">*</span>
                                </label>
                                <input type="password" name="contact_password_confirmation" required
                                       class="w-full px-4 py-3 border-2 border-gray-200 rounded-lg focus:border-green-500 transition"
                                       placeholder="Re-enter password">
                            </div>
                        </div>
                        
                        
                        <div class="mt-6 p-4 bg-gray-50 rounded-lg">
                            <label class="flex items-start cursor-pointer">
                                <input type="checkbox" name="terms" required
                                       class="w-4 h-4 text-green-600 border-gray-300 rounded focus:ring-green-500 mt-1">
                                <span class="ml-3 text-sm text-gray-600">
                                    I agree to the <a href="#" class="text-green-600 hover:text-green-700">Terms of Service</a> 
                                    and <a href="#" class="text-green-600 hover:text-green-700">Privacy Policy</a>.
                                    I confirm that I am authorized to register this institution.
                                </span>
                            </label>
                        </div>
                        
                        
                        <?php if($requiresPayment): ?>
                            <div class="mt-6 p-4 bg-yellow-50 border border-yellow-200 rounded-lg">
                                <div class="flex items-start">
                                    <i class="fas fa-exclamation-triangle text-yellow-500 mt-0.5 mr-3"></i>
                                    <div>
                                        <h4 class="font-semibold text-yellow-800">Payment Required</h4>
                                        <p class="text-yellow-700 text-sm">
                                            After registration, you will be redirected to complete payment of 
                                            <strong>SSP <?php echo e(number_format($paymentConfig->amount_ssp)); ?></strong>
                                            to publish your listing.
                                        </p>
                                    </div>
                                </div>
                            </div>
                        <?php endif; ?>
                    </fieldset>
                </div>
                
                
                <div class="mt-8 flex justify-between">
                    <button type="button" 
                            @click="prevStep()"
                            x-show="step > 1"
                            class="px-6 py-3 bg-gray-200 text-gray-700 font-semibold rounded-lg hover:bg-gray-300 transition">
                        <i class="fas fa-arrow-left mr-2"></i>Previous
                    </button>
                    
                    <div class="ml-auto flex gap-3">
                        <button type="button" 
                                @click="nextStep()"
                                x-show="step < totalSteps"
                                class="px-6 py-3 bg-green-600 text-white font-semibold rounded-lg hover:bg-green-700 transition">
                            Next Step<i class="fas fa-arrow-right ml-2"></i>
                        </button>
                        
                        <button type="submit" 
                                x-show="step === totalSteps"
                                class="px-8 py-3 bg-gradient-to-r from-green-600 to-green-700 text-white font-semibold rounded-lg hover:from-green-700 hover:to-green-800 transition shadow-lg">
                            <i class="fas fa-check mr-2"></i>Complete Registration
                        </button>
                    </div>
                </div>
            </form>
        </div>
    </section>
    
    
    <section class="py-12 bg-white">
        <div class="max-w-7xl mx-auto px-4 sm:px-6 lg:px-8">
            <h2 class="text-2xl font-bold text-gray-800 text-center mb-8">Why List With Us?</h2>
            
            <div class="grid grid-cols-1 md:grid-cols-3 gap-8">
                <div class="text-center p-6">
                    <div class="w-16 h-16 bg-green-100 rounded-full flex items-center justify-center mx-auto mb-4">
                        <i class="fas fa-users text-2xl text-green-600"></i>
                    </div>
                    <h3 class="font-semibold text-gray-800 mb-2">Reach More Patients</h3>
                    <p class="text-gray-600">Connect with thousands of patients actively searching for healthcare services.</p>
                </div>
                
                <div class="text-center p-6">
                    <div class="w-16 h-16 bg-green-100 rounded-full flex items-center justify-center mx-auto mb-4">
                        <i class="fas fa-chart-line text-2xl text-green-600"></i>
                    </div>
                    <h3 class="font-semibold text-gray-800 mb-2">Grow Your Practice</h3>
                    <p class="text-gray-600">Increase visibility and attract new patients to your facility.</p>
                </div>
                
                <div class="text-center p-6">
                    <div class="w-16 h-16 bg-green-100 rounded-full flex items-center justify-center mx-auto mb-4">
                        <i class="fas fa-clock text-2xl text-green-600"></i>
                    </div>
                    <h3 class="font-semibold text-gray-800 mb-2">24/7 Visibility</h3>
                    <p class="text-gray-600">Your listing is available around the clock for patients to discover.</p>
                </div>
            </div>
        </div>
    </section>
 <?php echo $__env->renderComponent(); ?>
<?php endif; ?>
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