{{ include('common/header.twig') }}
<div class="page-title">
    <div class="row align-items-center">
        <div class="col-sm-12">
            <h2 class="page-title-text d-inline-block">{{ page_title }}</h2>
            <div class="breadcrumbs d-inline-block">
                <ul>
                    <li><a href="{{ common.info.url }}">Dashboard</a></li>
                    <li>{{ page_title }}</li>
                </ul>
            </div>
        </div>
    </div>
</div>
<form action="{{ action }}" class="row" method="post">
    <div class="col-md-8">
        <div class="panel panel-default">
            <div class="panel-body">
                <input type="hidden" name="_token" value="{{ common.token }}">
                <div class="row">
                    <div class="col-md-6">
                        <div class="form-group">
                            <label>Name <span class="form-required">*</span></label>
                            <div class="input-group">
                                <div class="input-group-prepend"><span class="input-group-text"><i class="las la-user"></i></span></div>
                                <input type="text" name="receiver[name]" class="form-control" placeholder="Enter Name . . ." required>
                            </div>
                        </div>
                    </div>
                    <div class="col-md-6">
                        <div class="form-group">
                            <label>Email Address <span class="form-required">*</span></label>
                            <div class="input-group">
                                <div class="input-group-prepend"><span class="input-group-text"><i class="las la-envelope"></i></span></div>
                                <input type="text" name="receiver[email]" class="form-control" placeholder="Enter Email Address . . ." required>
                            </div>
                        </div>
                    </div>
                </div>
                <div class="form-group">
                    <label>Subject <span class="form-required">*</span></label>
                    <div class="input-group">
                        <div class="input-group-prepend"><span class="input-group-text"><i class="las la-comment"></i></span></div>
                        <input type="text" name="receiver[subject]" class="form-control" placeholder="Enter Subject . . ." required>
                    </div>
                </div>
                <div class="form-group">
                    <label>Message</label>
                    <textarea name="receiver[message]" class="summernote"></textarea>
                </div>
            </div>
            <div class="panel-footer text-center">
                <button type="submit" name="submit" class="btn btn-primary"><i class="ti-save-alt pr-2"></i> Save</button>
            </div>
        </div>
    </div>
</form>

<!-- include summernote css/js-->
<link href="public/css/summernote-bs4.css" rel="stylesheet">
<script type="text/javascript" src="public/js/summernote-bs4.min.js"></script>
<script type="text/javascript" src="public/js/klinikal.summernote.js"></script>
{{ include('common/footer.twig') }}