{!! Form::select('branch_id')
-> options(trans('patient::patient.options.branch_id'))
-> label(trans('patient::patient.label.branch_id'))
-> placeholder(trans('patient::patient.placeholder.branch_id'))!!}
{!! Form::select('physician_id')
-> options(trans('patient::patient.options.physician_id'))
-> label(trans('patient::patient.label.physician_id'))
-> placeholder(trans('patient::patient.placeholder.physician_id'))!!}
{!! Form::select('source_id')
-> options(trans('patient::patient.options.source_id'))
-> label(trans('patient::patient.label.source_id'))
-> placeholder(trans('patient::patient.placeholder.source_id'))!!}
{!! Form::select('primary_physician')
-> options(trans('patient::patient.options.primary_physician'))
-> label(trans('patient::patient.label.primary_physician'))
-> placeholder(trans('patient::patient.placeholder.primary_physician'))!!}
{!! Form::select('referring_physician')
-> options(trans('patient::patient.options.referring_physician'))
-> label(trans('patient::patient.label.referring_physician'))
-> placeholder(trans('patient::patient.placeholder.referring_physician'))!!}
{!! Form::text('title')
-> label(trans('patient::patient.label.title'))
-> placeholder(trans('patient::patient.placeholder.title'))!!}
{!! Form::email('email')
-> label(trans('patient::patient.label.email'))
-> placeholder(trans('patient::patient.placeholder.email'))!!}
{!! Form::password('password')
-> label(trans('patient::patient.label.password'))
-> placeholder(trans('patient::patient.placeholder.password'))!!}
{!! Form::text('first')
-> label(trans('patient::patient.label.first'))
-> placeholder(trans('patient::patient.placeholder.first'))!!}
{!! Form::text('middle')
-> label(trans('patient::patient.label.middle'))
-> placeholder(trans('patient::patient.placeholder.middle'))!!}
{!! Form::text('last')
-> label(trans('patient::patient.label.last'))
-> placeholder(trans('patient::patient.placeholder.last'))!!}
{!! Form::select('suffix')
-> options(trans('patient::patient.options.suffix'))
-> label(trans('patient::patient.label.suffix'))
-> placeholder(trans('patient::patient.placeholder.suffix'))!!}
{!! Form::text('preferred')
-> label(trans('patient::patient.label.preferred'))
-> placeholder(trans('patient::patient.placeholder.preferred'))!!}
{!! Form::select('type')
-> options(trans('patient::patient.options.type'))
-> label(trans('patient::patient.label.type'))
-> placeholder(trans('patient::patient.placeholder.type'))!!}
{!! Form::inline_radios('insured')
-> radios(trans('patient::patient.options.insured'))
-> label(trans('patient::patient.label.insured'))!!}
{!! Form::inline_radios('speech')
-> radios(trans('patient::patient.options.speech'))
-> label(trans('patient::patient.label.speech'))!!}
{!! Form::inline_radios('tinnitus')
-> radios(trans('patient::patient.options.tinnitus'))
-> label(trans('patient::patient.label.tinnitus'))!!}
{!! Form::inline_radios('gender')
-> radios(trans('patient::patient.options.gender'))
-> label(trans('patient::patient.label.gender'))!!}
{!! Form::text('languages')
-> label(trans('patient::patient.label.languages'))
-> placeholder(trans('patient::patient.placeholder.languages'))!!}
{!! Form::text('phone')
-> label(trans('patient::patient.label.phone'))
-> placeholder(trans('patient::patient.placeholder.phone'))!!}
{!! Form::text('mobile')
-> label(trans('patient::patient.label.mobile'))
-> placeholder(trans('patient::patient.placeholder.mobile'))!!}
{!! Form::textarea ('referral_description')
-> label(trans('patient::patient.label.referral_description'))
-> placeholder(trans('patient::patient.placeholder.referral_description'))!!}
{!! Form::inline_radios('employement')
-> radios(trans('patient::patient.options.employement'))
-> label(trans('patient::patient.label.employement'))!!}
{!! Form::text('employer')
-> label(trans('patient::patient.label.employer'))
-> placeholder(trans('patient::patient.placeholder.employer'))!!}
{!! Form::text('occupation')
-> label(trans('patient::patient.label.occupation'))
-> placeholder(trans('patient::patient.placeholder.occupation'))!!}
{!! Form::inline_radios('student_status')
-> radios(trans('patient::patient.options.student_status'))
-> label(trans('patient::patient.label.student_status'))!!}
{!! Form::text('school')
-> label(trans('patient::patient.label.school'))
-> placeholder(trans('patient::patient.placeholder.school'))!!}
{!! Form::inline_radios('maritial_status')
-> radios(trans('patient::patient.options.maritial_status'))
-> label(trans('patient::patient.label.maritial_status'))!!}
{!! Form::select('previous_provider')
-> options(trans('patient::patient.options.previous_provider'))
-> label(trans('patient::patient.label.previous_provider'))
-> placeholder(trans('patient::patient.placeholder.previous_provider'))!!}
{!! Form::text('previous_provider_phone')
-> label(trans('patient::patient.label.previous_provider_phone'))
-> placeholder(trans('patient::patient.placeholder.previous_provider_phone'))!!}
{!! Form::textarea ('notes')
-> label(trans('patient::patient.label.notes'))
-> placeholder(trans('patient::patient.placeholder.notes'))!!}
{!! Form::text('custom_groups')
-> label(trans('patient::patient.label.custom_groups'))
-> placeholder(trans('patient::patient.placeholder.custom_groups'))!!}