File: /var/www/vhost/disk-apps/dev-telemedicina.teky.com.co/resources/views/agenda/modal_cita.blade.php
<div class="modal fade" id="modal-cita" style="display: none;">
<div class="modal-dialog" style="width: 40%; ">
<div class="modal-content" style="height: 100%;">
<div class="modal-header">
<button type="button" class="close" data-dismiss="modal" aria-label="Close">
<span aria-hidden="true">×</span>
</button>
<h4 class="modal-title">Agendar</h4>
</div>
<div class="modal-body">
<div class="row">
<div class="col-xs-4">
<label for="exampleFormControlInput1">{{ __('messages.agenda.patient') }}</label>
<input type="text" class="form-control" name="" id="user_document" />
</div>
<div class="col-xs-4">
<label for="exampleFormControlInput1">{{ __('messages.agenda.name') }}</label>
<input type="text" class="form-control" name="" id="name" readonly />
</div>
</div>
<div class="row" style="margin-top: 10px">
<div class="col-xs-12">
<label for="exampleFormControlInput1">Tipo de solicitud</label>
<select class="form-control" name="date_type" id="date_type">
<option value="1">Primera vez</option>
<option value="2">Seguimiento o control</option>
</select>
</div>
</div>
</div>
<div class="modal-footer">
<button id="btn-create-date" type="button" class="btn btn-default pull-left" onclick="createAppointment()" data-dismiss="modal" data-event_id="">
Agendar
</button>
<button type="button" class="btn btn-default pull-right" data-dismiss="modal">
{{ __('messages.agenda_modal.tag_3') }}
</button>
</div>
</div>
<!-- /.modal-content -->
</div>
<!-- /.modal-dialog -->
</div>
<script type="text/javascript">
</script>