{"status":false,"msg":"<link href=\"/assets/986d27ad/css/bootstrap.css\" rel=\"stylesheet\">\n<link href=\"/assets/19a4bad6/css/activeform.min.css\" rel=\"stylesheet\">\n<script>var inputmask_66904920 = {\"removeMaskOnSubmit\":true,\"mask\":\"999-999-9999\"};</script>\n<div class=\"modal-header\">\n    <h5 class=\"modal-title\">Confirm Appointment</h5>\n    <button type=\"button\" class=\"close\" data-dismiss=\"modal\" aria-label=\"Close\">\n        <span aria-hidden=\"true\">×</span>\n    </button>\n</div>\n\n<form id=\"tipo-form\" class=\"kt-form kt-form--fit kt-form--label-align-right form-vertical kv-form-bs4\" action=\"/en/modal/104/yaz-mir-spa-matriz\" method=\"post\">\n<input type=\"hidden\" name=\"_csrf-frontend\" value=\"r-Tq5hmLHx9O5ei5P9T4HYNn-4kadT9lxKk7PixN4rScnd2NLMJLXQKm0NBPsL5ts1Kc7XdGa1WU2mRofByXxg==\"><div class=\"modal-body\">\n    <div class=\"form-group highlight-addon field-clinicboxautoagenda-nombre required\">\n<label class=\"has-star\" for=\"clinicboxautoagenda-nombre\">Name</label>\n\n<input type=\"text\" id=\"clinicboxautoagenda-nombre\" class=\"form-control\" name=\"ClinicboxAutoagenda[nombre]\" maxlength=\"100\" title=\"Name\" placeholder=\"Name\" data-toggle=\"tooltip\" data-placement=\"bottom\" aria-required=\"true\">\n\n<div class=\"invalid-feedback\"></div>\n\n</div>\n    <div class=\"form-group highlight-addon field-clinicboxautoagenda-telefono required\">\n<label class=\"has-star\" for=\"clinicboxautoagenda-telefono\">Phone</label>\n\n<input type=\"text\" id=\"clinicboxautoagenda-telefono\" class=\"form-control\" name=\"ClinicboxAutoagenda[telefono]\" aria-required=\"true\" data-plugin-inputmask=\"inputmask_66904920\">\n\n<div class=\"invalid-feedback\"></div>\n\n</div>\n    <div class=\"form-group highlight-addon field-clinicboxautoagenda-email\">\n<label class=\"has-star\" for=\"clinicboxautoagenda-email\">Email</label>\n\n<input type=\"text\" id=\"clinicboxautoagenda-email\" class=\"form-control\" name=\"ClinicboxAutoagenda[email]\" maxlength=\"50\" title=\"Email\" placeholder=\"Email\" data-toggle=\"tooltip\" data-placement=\"bottom\">\n\n<div class=\"invalid-feedback\"></div>\n\n</div></div>\n<div class=\"modal-footer\" style=\"background-color: #F3F6F9 !important\">\n    <button type=\"button\" class=\"btn btn-secondary\" data-dismiss=\"modal\"><i class=\"flaticon-circle\"></i> Cancel\n    </button>\n    <button type=\"submit\" class=\"btn btn-primary\"><i class=\"flaticon-edit\"></i> Confirm</button>\n</div>\n\n</form>\n<script src=\"/assets/ab08634b/jquery.js\"></script>\n<script src=\"/assets/639a9183/yii.js\"></script>\n<script src=\"/assets/639a9183/yii.activeForm.js\"></script>\n<script src=\"/assets/986d27ad/js/bootstrap.bundle.js\"></script>\n<script src=\"/assets/19a4bad6/js/activeform.min.js\"></script>\n<script src=\"/assets/ed6bb381/jquery.inputmask.bundle.js\"></script>\n<script>    $(\"#tipo-form\").on('beforeSubmit', function (e) {\n        $.ajax({\n            type: 'POST',\n            url: '/en/modal/104',\n            data: $(\"#tipo-form\").serialize(),       \n            dataType: 'json',     \n            success: function (data) {\n                if (data.status) {\n                    toastr.success(data.msg, 'Exito')\n                    $(\"#modal-win\").modal('hide');\n                    setTimeout(function(){ window.location.href = data.link; }, 2000);\n                } else {\n                    $(\"#modal-win .modal-content\").html(data.msg);\n                }\n            }\n        });\n        return false;\n    });\nvar $el=jQuery(\"#tipo-form .kv-hint-special\");if($el.length){$el.each(function(){$(this).activeFieldHint()});}kvBs4InitForm();\njQuery(\"#clinicboxautoagenda-telefono\").inputmask(inputmask_66904920);\njQuery('#tipo-form').yiiActiveForm([], []);</script>"}