@extends('layouts.user')

@section('title', 'Data Diri')

@section('content')

<div class="container">
    <h4 class="mb-4">Isi Data Diri Anda Sebelum Diagnosa</h4>

    <form action="{{ route('user.data_diri.store') }}" method="POST">
        @csrf

        <div class="mb-3">
            <label>Nama Lengkap</label>
            <input type="text" name="nama" class="form-control" required>
        </div>

        <div class="mb-3">
            <label>Jenis Kelamin</label>
            <select name="jenis_kelamin" class="form-control">
                <option>Laki-laki</option>
                <option>Perempuan</option>
            </select>
        </div>

        <div class="mb-3">
            <label>Tempat Lahir</label>
            <input type="text" name="tempat_lahir" class="form-control">
        </div>

        <div class="mb-3">
            <label>Tanggal Lahir</label>
            <input type="date" name="tanggal_lahir" class="form-control">
        </div>

        <div class="mb-3">
            <label>Alamat</label>
            <textarea name="alamat" class="form-control"></textarea>
        </div>

        <div class="mb-3">
            <label>No Telp</label>
            <input type="text" name="no_telp" class="form-control">
        </div>

        <button class="btn btn-primary">Simpan & Lanjut Diagnosa</button>
    </form>
</div>

@endsection