<link href="//maxcdn.bootstrapcdn.com/bootstrap/4.1.1/css/bootstrap.min.css" rel="stylesheet" id="bootstrap-css">
<script src="//maxcdn.bootstrapcdn.com/bootstrap/4.1.1/js/bootstrap.min.js"></script>
<script src="//cdnjs.cloudflare.com/ajax/libs/jquery/2.2.4/jquery.min.js"></script>
<!------ Include the above in your HEAD tag ---------->
<!DOCTYPE html>
<html>
<head>
<script src="//code.jquery.com/jquery-1.11.1.min.js"></script>
<link href="//maxcdn.bootstrapcdn.com/bootstrap/3.3.0/css/bootstrap.min.css" rel="stylesheet" id="bootstrap-css">
<script src="//maxcdn.bootstrapcdn.com/bootstrap/3.3.0/js/bootstrap.min.js"></script>
<!------ Include the above in your HEAD tag ---------->
</head>
<body>
<form class="form-horizontal" id='cadastroNovoCliente'>
<fieldset>
<div class="panel panel-success">
<div class="panel-heading">Cadastro de Cliente</div>
<div class="panel-body">
<div class="form-group">
<div class="col-md-11 control-label">
<p class="help-block"><h11>*</h11> Campo Obrigatório </p>
</div>
</div>
<!-- Text input-->
<div class="form-group">
<label class="col-md-2 control-label" for="Nome">Nome <h11>*</h11></label>
<div class="col-md-8">
<input id="Nome" name="Nome" placeholder="" class="form-control input-md" required="" type="text">
</div>
</div>
<!-- Text input-->
<div class="form-group">
<label class="col-md-2 control-label" for="Nome">CPF <h11>*</h11></label>
<div class="col-md-2">
<input id="cpf" name="cpf" placeholder="Apenas números" class="form-control input-md" required="" type="text" maxlength="11" pattern="[0-9]+$">
</div>
<label class="col-md-1 control-label" for="Nome">Nascimento<h11>*</h11></label>
<div class="col-md-2">
<input id="dtnasc" name="dtnasc" placeholder="DD/MM/AAAA" class="form-control input-md" required="" type="text" maxlength="10" OnKeyPress="formatar('##/##/####', this)" onBlur="showhide()">
</div>
<!-- Multiple Radios (inline) -->
<label class="col-md-1 control-label" for="radios">Sexo <h11>*</h11></label>
<div class="col-md-4">
<label required="" class="radio-inline" for="radios-0" >
<input name="sexo" id="sexo" value="feminino" type="radio" required>
Feminino
</label>
<label class="radio-inline" for="radios-1">
<input name="sexo" id="sexo" value="masculino" type="radio">
Masculino
</label>
</div>
</div>
<!-- Prepended text-->
<div class="form-group">
<label class="col-md-2 control-label" for="prependedtext">Telefone <h11>*</h11></label>
<div class="col-md-2">
<div class="input-group">
<span class="input-group-addon"><i class="glyphicon glyphicon-earphone"></i></span>
<input id="prependedtext" name="prependedtext" class="form-control" placeholder="XX XXXXX-XXXX" required="" type="text" maxlength="13" pattern="\[0-9]{2}\ [0-9]{4,6}-[0-9]{3,4}$"
OnKeyPress="formatar('## #####-####', this)">
</div>
</div>
<label class="col-md-1 control-label" for="prependedtext">Telefone</label>
<div class="col-md-2">
<div class="input-group">
<span class="input-group-addon"><i class="glyphicon glyphicon-earphone"></i></span>
<input id="prependedtext" name="prependedtext" class="form-control" placeholder="XX XXXXX-XXXX" type="text" maxlength="13" pattern="\[0-9]{2}\ [0-9]{4,6}-[0-9]{3,4}$"
OnKeyPress="formatar('## #####-####', this)">
</div>
</div>
</div>
<!-- Prepended text-->
<div class="form-group">
<label class="col-md-2 control-label" for="prependedtext">Email <h11>*</h11></label>
<div class="col-md-5">
<div class="input-group">
<span class="input-group-addon"><i class="glyphicon glyphicon-envelope"></i></span>
<input id="prependedtext" name="prependedtext" class="form-control" placeholder="email@email.com" required="" type="text" pattern="[a-z0-9._%+-]+@[a-z0-9.-]+\.[a-z]{2,4}$" >
</div>
</div>
</div>
<!-- Search input-->
<div class="form-group">
<label class="col-md-2 control-label" for="CEP">CEP <h11>*</h11></label>
<div class="col-md-2">
<input id="cep" name="cep" placeholder="Apenas números" class="form-control input-md" required="" value="" type="search" maxlength="8" pattern="[0-9]+$">
</div>
<div class="col-md-2">
<button type="button" class="btn btn-primary" onclick="pesquisacep(cep.value)">Pesquisar</button>
</div>
</div>
<!-- Prepended text-->
<div class="form-group">
<label class="col-md-2 control-label" for="prependedtext">Endereço</label>
<div class="col-md-4">
<div class="input-group">
<span class="input-group-addon">Rua</span>
<input id="rua" name="rua" class="form-control" placeholder="" required="" readonly="readonly" type="text">
</div>
</div>
<div class="col-md-2">
<div class="input-group">
<span class="input-group-addon">Nº <h11>*</h11></span>
<input id="numero" name="numero" class="form-control" placeholder="" required="" type="text">
</div>
</div>
<div class="col-md-3">
<div class="input-group">
<span class="input-group-addon">Bairro</span>
<input id="bairro" name="bairro" class="form-control" placeholder="" required="" readonly="readonly" type="text">
</div>
</div>
</div>
<div class="form-group">
<label class="col-md-2 control-label" for="prependedtext"></label>
<div class="col-md-4">
<div class="input-group">
<span class="input-group-addon">Cidade</span>
<input id="cidade" name="cidade" class="form-control" placeholder="" required="" readonly="readonly" type="text">
</div>
</div>
<div class="col-md-2">
<div class="input-group">
<span class="input-group-addon">Estado</span>
<input id="estado" name="estado" class="form-control" placeholder="" required="" readonly="readonly" type="text">
</div>
</div>
</div>
<!-- Select Basic -->
<div class="form-group">
<label class="col-md-2 control-label" for="Estado Civil">Estado Civil <h11>*</h11></label>
<div class="col-md-2">
<select required id="Estado Civil" name="Estado Civil" class="form-control">
<option value=""></option>
<option value="Solteiro(a)">Solteiro(a)</option>
<option value="Casado(a)">Casado(a)</option>
<option value="Divorciado(a)">Divorciado(a)</option>
<option value="Viuvo(a)">Viuvo(a)</option>
</select>
</div>
<!-- Prepended checkbox -->
<label class="col-md-1 control-label" for="Filhos">Filhos<h11>*</h11></label>
<div class="col-md-3">
<div class="input-group">
<span class="input-group-addon">
<label class="radio-inline label-radio" for="radios-0">
<input type="radio" name="filhos" id="filhos" value="nao" onclick="desabilita('filhos_qtd')" required>
Não
</label>
<label class="radio-inline label-radio" for="radios-1">
<input type="radio" name="filhos" id="filhos" value="sim" onclick="habilita('filhos_qtd')">
Sim
</label>
</span>
<input id="filhos_qtd" name="filhos_qtd" class="form-control" type="text" placeholder="Quantos?" pattern="[0-9]+$" >
</div>
</div>
</div>
<!-- Select Basic -->
<div class="form-group">
<label class="col-md-2 control-label" for="selectbasic">Escolaridade <h11>*</h11></label>
<div class="col-md-3">
<select required id="escolaridade" name="escolaridade" class="form-control">
<option value=""></option>
<option value="Analfabeto">Analfabeto</option>
<option value="Fundamental Incompleto">Fundamental Incompleto</option>
<option value="Fundamental Completo">Fundamental Completo</option>
<option value="Médio Incompleto">Médio Incompleto</option>
<option value="Médio Completo">Médio Completo</option>
<option value="Superior Incompleto">Superior Incompleto</option>
<option value="Superior Completo">Superior Completo</option>
</select>
</div>
<!-- Text input-->
<label class="col-md-1 control-label" for="profissao">Profissão<h11>*</h11></label>
<div class="col-md-4">
<input id="profissao" name="profissao" type="text" placeholder="" class="form-control input-md" required="">
</div>
</div>
<div class="form-group">
<label class="col-md-2 control-label" for="encaminhamento">Encaminhamento <h11>*</h11></label>
<div class="col-md-4">
<div class="input-group">
<span class="input-group-addon">
<label class="radio-inline label-radio" for="radios-0">
<input type="radio" name="enc" id="enc" value="Nao" onclick="desabilita('enc_instituicao')" required>
Não
</label>
<label class="radio-inline label-radio" for="radios-1">
<input type="radio" name="enc" id="enc" value="sim" onclick="habilita('enc_instituicao')">
Sim
</label>
</span>
<input id="enc_instituicao" name="enc" class="form-control" type="text" placeholder="Instituição" >
</div>
</div>
<label class="col-md-1 control-label" for="encaminhamento">Aluno FIAP<h11>*</h11></label>
<div class="col-md-4">
<div class="input-group">
<span class="input-group-addon">
<label class="radio-inline label-radio" for="radios-0">
<input type="radio" name="aluno" id="enc" value="Nao" required>
Não
</label>
<label class="radio-inline label-radio" for="radios-1">
<input type="radio" name="aluno" id="enc" value="sim">
Sim
</label>
</span>
<input id="enc" name="curso" class="form-control" type="text" placeholder="Curso" >
</div>
</div>
</div>
<!-- Text input-->
<div class="form-group">
<label class="col-md-2 control-label" for="textinput">Como ficou sabendo da Clínica?</label>
<div class="col-md-4">
<input id="textinput" name="textinput" placeholder="" class="form-control input-md" type="text">
</div>
</div>
<div id="newpost">
<div class="form-group">
<div class="col-md-2 control-label">
<h3>Responsável</h3>
</div>
</div>
<div class="form-group">
<label class="col-md-2 control-label" for="Nome">Nome <h11>*</h11></label>
<div class="col-md-8">
<input id="Nome" name="Nome" placeholder="" class="form-control input-md" required="" type="text">
</div>
</div>
<!-- Text input-->
<div class="form-group">
<label class="col-md-2 control-label" for="vinculo">Vinculo com cliente <h11>*</h11></label>
<div class="col-md-2">
<input id="vinculo" name="vinculo" placeholder="" class="form-control input-md" required="" type="text" pattern="/^[A-Za-záàâãéèêíïóôõöúçñÁÀÂÃÉÈÍÏÓÔÕÖÚÇÑ ]+$/">
</div>
<label class="col-md-1 control-label" for="Nome">Nascimento<h11>*</h11></label>
<div class="col-md-2">
<input id="dtnasc" name="dtnasc" placeholder="DD/MM/AAAA" class="form-control input-md" required="" type="text" maxlength="10" OnKeyPress="formatar('##/##/####', this)">
</div>
<!-- Multiple Radios (inline) -->
<label class="col-md-1 control-label" for="radios">Sexo <h11>*</h11></label>
<div class="col-md-4">
<label required="" class="radio-inline" for="radios-0" >
<input name="sexo" id="sexo" value="feminino" type="radio" required>
Feminino
</label>
<label class="radio-inline" for="radios-1">
<input name="sexo" id="sexo" value="masculino" type="radio">
Masculino
</label>
</div>
</div>
<div class="form-group">
<label class="col-md-2 control-label" for="Estado Civil">Estado Civil <h11>*</h11></label>
<div class="col-md-2">
<select required id="Estado Civil" name="Estado Civil" class="form-control">
<option value=""></option>
<option value="Solteiro(a)">Solteiro(a)</option>
<option value="Casado(a)">Casado(a)</option>
<option value="Divorciado(a)">Divorciado(a)</option>
<option value="Viuvo(a)">Viuvo(a)</option>
</select>
</div>
<label class="col-md-1 control-label" for="Filhos">Filhos<h11>*</h11></label>
<div class="col-md-3">
<div class="input-group">
<span class="input-group-addon">
<label class="radio-inline label-radio" for="radios-0">
<input type="radio" name="ofilhos" id="ofilhos" value="nao" onclick="desabilita('ofilhos_qtd')" required>
Não
</label>
<label class="radio-inline label-radio" for="radios-1">
<input type="radio" name="ofilhos" id="ofilhos" value="sim" onclick="habilita('ofilhos_qtd')">
Sim
</label>
</span>
<input id="ofilhos_qtd" name="ofilhos_qtd" class="form-control" type="text" placeholder="Quantos?" pattern="[0-9]+$" >
</div>
</div>
</div>
<div class="form-group">
<label class="col-md-2 control-label" for="selectbasic">Escolaridade <h11>*</h11></label>
<div class="col-md-3">
<select required id="escolaridade" name="escolaridade" class="form-control">
<option value=""></option>
<option value="Analfabeto">Analfabeto</option>
<option value="Fundamental Incompleto">Fundamental Incompleto</option>
<option value="Fundamental Completo">Fundamental Completo</option>
<option value="Médio Incompleto">Médio Incompleto</option>
<option value="Médio Completo">Médio Completo</option>
<option value="Superior Incompleto">Superior Incompleto</option>
<option value="Superior Completo">Superior Completo</option>
</select>
</div>
<!-- Text input-->
<label class="col-md-1 control-label" for="profissao">Profissão<h11>*</h11></label>
<div class="col-md-4">
<input id="profissao" name="profissao" type="text" placeholder="" class="form-control input-md" required="">
</div>
</div>
<div class="form-group">
<label class="col-md-2 control-label" for="prependedtext">Telefone <h11>*</h11></label>
<div class="col-md-2">
<div class="input-group">
<span class="input-group-addon"><i class="glyphicon glyphicon-earphone"></i></span>
<input id="prependedtext" name="prependedtext" class="form-control" placeholder="XX XXXXX-XXXX" required="" type="text" maxlength="13" pattern="\[0-9]{2}\ [0-9]{4,6}-[0-9]{3,4}$"
OnKeyPress="formatar('## #####-####', this)">
</div>
</div>
<label class="col-md-1 control-label" for="prependedtext">Telefone</label>
<div class="col-md-2">
<div class="input-group">
<span class="input-group-addon"><i class="glyphicon glyphicon-earphone"></i></span>
<input id="prependedtext" name="prependedtext" class="form-control" placeholder="XX XXXXX-XXXX" type="text" maxlength="13" pattern="\[0-9]{2}\ [0-9]{4,6}-[0-9]{3,4}$"
OnKeyPress="formatar('## #####-####', this)">
</div>
</div>
</div>
<div class="form-group">
<label class="col-md-2 control-label" for="prependedtext">Email <h11>*</h11></label>
<div class="col-md-5">
<div class="input-group">
<span class="input-group-addon"><i class="glyphicon glyphicon-envelope"></i></span>
<input id="prependedtext" name="prependedtext" class="form-control" placeholder="email@email.com" required="" type="text" pattern="[a-z0-9._%+-]+@[a-z0-9.-]+\.[a-z]{2,4}$" >
</div>
</div>
</div>
</div>
<!-- Button (Double) -->
<div class="form-group">
<label class="col-md-2 control-label" for="Cadastrar"></label>
<div class="col-md-8">
<button id="Cadastrar" name="Cadastrar" class="btn btn-success" type="Submit">Cadastrar</button>
<button id="Cancelar" name="Cancelar" class="btn btn-danger" type="Reset">Cancelar</button>
</div>
</div>
</div>
</div>
</fieldset>
</form>
</body>
</html>
h11 {
color:red;
}
#logo {
width:50%;
height:50%;
}
.panel-heading{
font-size:150%;
}
.label-radio {
margin-top: 0px !important;
padding-top: 0px !important;
}
function limpa_formulario_cep() {
//Limpa valores do formulário de cep.
document.getElementById('rua').value=("");
document.getElementById('bairro').value=("");
document.getElementById('cidade').value=("");
document.getElementById('estado').value=("");
}
function meu_callback(conteudo) {
if (!("erro" in conteudo)) {
//Atualiza os campos com os valores.
document.getElementById('rua').value=(conteudo.logradouro);
document.getElementById('bairro').value=(conteudo.bairro);
document.getElementById('cidade').value=(conteudo.localidade);
document.getElementById('estado').value=(conteudo.uf);
} //end if.
else {
//CEP não Encontrado.
limpa_formulario_cep();
alert("CEP não encontrado.");
document.getElementById('cep').value=("");
}
}
function pesquisacep(valor) {
//Nova variável "cep" somente com dígitos.
var cep = valor.replace(/\D/g, '');
//Verifica se campo cep possui valor informado.
if (cep !== "") {
//Expressão regular para validar o CEP.
var validacep = /^[0-9]{8}$/;
//Valida o formato do CEP.
if(validacep.test(cep)) {
//Preenche os campos com "..." enquanto consulta webservice.
document.getElementById('rua').value="...";
document.getElementById('bairro').value="...";
document.getElementById('cidade').value="...";
document.getElementById('estado').value="...";
//Cria um elemento javascript.
var script = document.createElement('script');
//Sincroniza com o callback.
script.src = '//viacep.com.br/ws/'+ cep + '/json/?callback=meu_callback';
//Insere script no documento e carrega o conteúdo.
document.body.appendChild(script);
} //end if.
else {
//cep é inválido.
limpa_formulario_cep();
alert("Formato de CEP inválido.");
}
} //end if.
else {
//cep sem valor, limpa formulário.
limpa_formulario_cep();
}
}
function formatar(mascara, documento){
var i = documento.value.length;
var saida = mascara.substring(0,1);
var texto = mascara.substring(i);
if (texto.substring(0,1) != saida){
documento.value += texto.substring(0,1);
}
}
function idade (){
var data=document.getElementById("dtnasc").value;
var dia=data.substr(0, 2);
var mes=data.substr(3, 2);
var ano=data.substr(6, 4);
var d = new Date();
var ano_atual = d.getFullYear(),
mes_atual = d.getMonth() + 1,
dia_atual = d.getDate();
ano=+ano,
mes=+mes,
dia=+dia;
var idade=ano_atual-ano;
if (mes_atual < mes || mes_atual == mes_aniversario && dia_atual < dia) {
idade--;
}
return idade;
}
function exibe(i) {
document.getElementById(i).readOnly= true;
}
function desabilita(i){
document.getElementById(i).disabled = true;
}
function habilita(i)
{
document.getElementById(i).disabled = false;
}
function showhide()
{
var div = document.getElementById("newpost");
if(idade()>=18){
div.style.display = "none";
}
else if(idade()<18) {
div.style.display = "inline";
}
}
$(document).ready(function() {
$("#cadastroNovoCliente").submit(function(e) {
e.preventDefault();
var form = $(this);
SendForm(form.serialize());
});
function SendForm(form){
var apiUrl = "https://myApi.com/api/cadastroCliente";
var token = MY_TOKEN;
$.ajax({
type: 'POST',
url: apiUrl,
data:form,
dataType: "json",
contentType: "application/json; charset=utf-8",
error: function(xhr,status,error){
console.log("error: " + error);
},
success: function(data) {
console.log("result: " + data);
}
});
}
});
