First Name getBag($__errorArgs[1] ?? 'default'); if ($__bag->has($__errorArgs[0])) : if (isset($message)) { $__messageOriginal = $message; } $message = $__bag->first($__errorArgs[0]); ?>

Last Name getBag($__errorArgs[1] ?? 'default'); if ($__bag->has($__errorArgs[0])) : if (isset($message)) { $__messageOriginal = $message; } $message = $__bag->first($__errorArgs[0]); ?>

Date of Birth getBag($__errorArgs[1] ?? 'default'); if ($__bag->has($__errorArgs[0])) : if (isset($message)) { $__messageOriginal = $message; } $message = $__bag->first($__errorArgs[0]); ?>

Gender getBag($__errorArgs[1] ?? 'default'); if ($__bag->has($__errorArgs[0])) : if (isset($message)) { $__messageOriginal = $message; } $message = $__bag->first($__errorArgs[0]); ?>

Address getBag($__errorArgs[1] ?? 'default'); if ($__bag->has($__errorArgs[0])) : if (isset($message)) { $__messageOriginal = $message; } $message = $__bag->first($__errorArgs[0]); ?>

Phone Number

getBag($__errorArgs[1] ?? 'default'); if ($__bag->has($__errorArgs[0])) : if (isset($message)) { $__messageOriginal = $message; } $message = $__bag->first($__errorArgs[0]); ?>

Aadhar Card Number Last 4 Digits getBag($__errorArgs[1] ?? 'default'); if ($__bag->has($__errorArgs[0])) : if (isset($message)) { $__messageOriginal = $message; } $message = $__bag->first($__errorArgs[0]); ?>

Patient Email getBag($__errorArgs[1] ?? 'default'); if ($__bag->has($__errorArgs[0])) : if (isset($message)) { $__messageOriginal = $message; } $message = $__bag->first($__errorArgs[0]); ?>

Photo getBag($__errorArgs[1] ?? 'default'); if ($__bag->has($__errorArgs[0])) : if (isset($message)) { $__messageOriginal = $message; } $message = $__bag->first($__errorArgs[0]); ?>

Blood Group (Optional)

A+

A-

B+

B-

AB+

AB-

O+

O-

getBag($__errorArgs[1] ?? 'default'); if ($__bag->has($__errorArgs[0])) : if (isset($message)) { $__messageOriginal = $message; } $message = $__bag->first($__errorArgs[0]); ?>

Organ Donors (Optional)

> I am an organ donor

getBag($__errorArgs[1] ?? 'default'); if ($__bag->has($__errorArgs[0])) : if (isset($message)) { $__messageOriginal = $message; } $message = $__bag->first($__errorArgs[0]); ?>

Aadhar Card getBag($__errorArgs[1] ?? 'default'); if ($__bag->has($__errorArgs[0])) : if (isset($message)) { $__messageOriginal = $message; } $message = $__bag->first($__errorArgs[0]); ?>

Disability getBag($__errorArgs[1] ?? 'default'); if ($__bag->has($__errorArgs[0])) : if (isset($message)) { $__messageOriginal = $message; } $message = $__bag->first($__errorArgs[0]); ?>

Select Vaccines

stopSection(); ?> make('layouts.app_without_header', array_diff_key(get_defined_vars(), ['__data' => 1, '__path' => 1]))->render(); ?>