{!! Form::numeric('patient_id')
-> label(trans('patient::contact.label.patient_id'))
-> placeholder(trans('patient::contact.placeholder.patient_id'))!!}
{!! Form::numeric('country')
-> label(trans('patient::contact.label.country'))
-> placeholder(trans('patient::contact.placeholder.country'))!!}
{!! Form::text('name')
-> label(trans('patient::contact.label.name'))
-> placeholder(trans('patient::contact.placeholder.name'))!!}
{!! Form::email('email')
-> label(trans('patient::contact.label.email'))
-> placeholder(trans('patient::contact.placeholder.email'))!!}
{!! Form::text('mobile')
-> label(trans('patient::contact.label.mobile'))
-> placeholder(trans('patient::contact.placeholder.mobile'))!!}
{!! Form::text('phone')
-> label(trans('patient::contact.label.phone'))
-> placeholder(trans('patient::contact.placeholder.phone'))!!}
{!! Form::text('fax')
-> label(trans('patient::contact.label.fax'))
-> placeholder(trans('patient::contact.placeholder.fax'))!!}
{!! Form::text('building')
-> label(trans('patient::contact.label.building'))
-> placeholder(trans('patient::contact.placeholder.building'))!!}
{!! Form::text('street')
-> label(trans('patient::contact.label.street'))
-> placeholder(trans('patient::contact.placeholder.street'))!!}
{!! Form::text('city')
-> label(trans('patient::contact.label.city'))
-> placeholder(trans('patient::contact.placeholder.city'))!!}
{!! Form::text('state')
-> label(trans('patient::contact.label.state'))
-> placeholder(trans('patient::contact.placeholder.state'))!!}
{!! Form::text('zip')
-> label(trans('patient::contact.label.zip'))
-> placeholder(trans('patient::contact.placeholder.zip'))!!}
{!! Form::inline_radios('default')
-> radios(trans('patient::contact.options.default'))
-> label(trans('patient::contact.label.default'))!!}
{!! Form::inline_radios('responsible')
-> radios(trans('patient::contact.options.responsible'))
-> label(trans('patient::contact.label.responsible'))!!}
{!! Form::inline_radios('type')
-> radios(trans('patient::contact.options.type'))
-> label(trans('patient::contact.label.type'))!!}
{!! Form::inline_radios('waiverings')
-> radios(trans('patient::contact.options.waiverings'))
-> label(trans('patient::contact.label.waiverings'))!!}
{!! Form::inline_radios('mailings')
-> radios(trans('patient::contact.options.mailings'))
-> label(trans('patient::contact.label.mailings'))!!}
{!! Form::inline_radios('callings')
-> radios(trans('patient::contact.options.callings'))
-> label(trans('patient::contact.label.callings'))!!}
{!! Form::inline_radios('textings')
-> radios(trans('patient::contact.options.textings'))
-> label(trans('patient::contact.label.textings'))!!}
{!! Form::inline_radios('emailings')
-> radios(trans('patient::contact.options.emailings'))
-> label(trans('patient::contact.label.emailings'))!!}