{{ form_start(form, { 'attr': { 'class': 'mt-12 ml-auto mr-20 lg:mr-16 bg-white shadow-md rounded-2xl px-8 pt-6 pb-8 mb-4 w-5/6 lg:w-2/5' } }) }}

{% if edit_mode %}

Modifier mon profil

Modification de mon profil {% endif %} {% if not app.user %}

Inscription

Remplissez les champs suivant afin de créer votre compte

{% endif %} {% if app.request.attributes.get('role') == "doctor" %}

Etape 1

Pour le compte praticien vous devez accédé à deux étape; voici l'étape 1.

{% endif %}

Sexe *

{{ form_row(form.gender, {'attr': {'class': 'text-2xl lg:text-base form-control w-full p-3 lg:p-2 flex items-center border rounded-lg required-step1'}}) }}

Date de naissance *

{{ form_row(form.dateBirth, {'attr': {'class': 'text-2xl lg:text-base form-control w-full p-3 lg:p-2 flex items-center border rounded-lg required-step1'}}) }}

Prénom *

{{ form_row(form.firstname, {'attr': {'class': 'text-2xl lg:text-base form-control w-full p-3 lg:p-2 flex items-center border rounded-lg required-step1'}}) }}

Téléphone *

{{ form_row(form.phoneNumber, {'attr': {'class': 'text-2xl lg:text-base form-control w-full p-3 lg:p-2 flex items-center border rounded-lg required-step1'}}) }}

Nom *

{{ form_row(form.lastname, {'attr': {'class': 'text-2xl lg:text-base form-control w-full p-3 lg:p-2 flex items-center border rounded-lg required-step1'}}) }}

Email *

{{ form_row(form.email, {'attr': {'class': 'text-2xl lg:text-base form-control w-full p-3 lg:p-2 flex items-center border rounded-lg required-step1'}}) }}

Adresse *

{{ form_row(form.street, {'attr': {'class': 'text-2xl lg:text-base form-control w-full p-3 lg:p-2 flex items-center border rounded-lg required-step1'}}) }}

Ville *

{{ form_row(form.city, {'attr': {'class': 'text-2xl lg:text-base form-control w-full p-3 lg:p-2 flex items-center border rounded-lg required-step1'}}) }}

{% if not edit_mode %}

Mot de passe *

{{ form_row(form.plainPassword.first, {'attr': {'class': 'text-2xl lg:text-base form-control w-full p-3 lg:p-2 flex items-center border rounded-lg required-step1', 'placeholder': 'Minimum 8 caractères'}}) }}

{% endif %}

Code postal *

{{ form_row(form.zipCode, {'attr': {'class': 'text-2xl lg:text-base form-control w-full p-3 lg:p-2 flex items-center border rounded-lg required-step1'}}) }}

{% if not edit_mode %}

Confirmez le mot de passe *

{{ form_row(form.plainPassword.second, {'attr': {'class': 'text-2xl lg:text-base form-control w-full p-3 lg:p-2 flex items-center border rounded-lg required-step1', 'placeholder': 'Confirmez votre mot de passe'}}) }}

J'accepte les conditions générales d'utilisation

{% endif %}

{% if app.request.get('role') == "doctor" %} {% else %} {% endif %}