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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>