<?php
		if (isset($con))
		{
	?>
	<!-- Modal -->
	<div class="modal fade" id="myModal" tabindex="-1" role="dialog" aria-labelledby="myModalLabel">
	  <div class="modal-dialog" role="document">
		<div class="modal-content">
		  <div class="modal-header">
			<button type="button" class="close" data-dismiss="modal" aria-label="Close"><span aria-hidden="true">&times;</span></button>
			<h4 class="modal-title" id="myModalLabel"><i class='glyphicon glyphicon-edit'></i> Agregar nueva Encuesta</h4>
		  </div>
		  <div class="modal-body">
			<form class="form-horizontal" method="post" id="form_ticket" name="form_ticket" enctype="multipart/form-data">
			<div id="resultados_ajax"></div>
			  <div class="form-group">
				<label for="firstname" class="col-sm-3 control-label">Ticket</label>
				<div class="col-sm-8">
				  <input type="text" placeholder="Ingrese Ticket" maxlength="6" class="form-control input-sm" required name="ticket" value="<?php //echo $row['ticket']?>" oninput="this.value = this.value.replace(/[^0-9]/g, ''); this.value = this.value.replace(/(\..*)\./g, '$1');" >
				</div>
			  </div>
			  <div class="form-group">
				<label for="lastname" class="col-sm-3 control-label">Numero de Encuesta</label>
				<div class="col-sm-8">
				  <input type="text" placeholder="Ingrese Numero de Encuesta" maxlength="4" class="form-control input-sm" required name="nro_encuesta" value="<?php //echo $row['nro_encuesta']?>"  oninput="this.value = this.value.replace(/[^0-9]/g, ''); this.value = this.value.replace(/(\..*)\./g, '$1');">
				</div>
			  </div>
			  <div class="form-group">
				<label for="user_name" class="col-sm-3 control-label">Tiempo de Respuesta</label>
				<div class="col-sm-8">

				 <div class="row">
	<div class="col-md-12">
		<div class="input-group ">
			<span class="input-group-addon input-sm">
				<input type="radio" name="tiempo_respuesta" id="tiempo_respuesta" value="Excelente" >
			</span>
			<label class="form-control input-sm">Excelente</label>
		</div>
	</div>
	<div class="col-md-12">
		<div class="input-group ">
			<span class="input-group-addon input-sm">
				<input type="radio" name="tiempo_respuesta" id="tiempo_respuesta" value="Bueno">
			</span>
			<label class="form-control input-sm">Bueno</label>
		</div>
	</div>
	<div class="col-md-12">
		<div class="input-group">
			<span class="input-group-addon input-sm">
				<input type="radio" name="tiempo_respuesta" id="tiempo_respuesta" value="Regular">
			</span>
			<label class="form-control input-sm">Regular</label>
		</div>
	</div>
	<div class="col-md-12">
		<div class="input-group">
			<span class="input-group-addon input-sm">
				<input type="radio" name="tiempo_respuesta" id="tiempo_respuesta" value="Malo">
			</span>
			<label class="form-control input-sm">Malo</label>
		</div>
	</div>
</div>
				</div>
			  </div>
			  <div class="form-group">
				<label for="email_corporativo" class="col-sm-3 control-label">Calidad de Servicio</label>
				<div class="col-sm-8">

				  <div class="row">
	<div class="col-md-12">
		<div class="input-group ">
			<span class="input-group-addon input-sm">
				<input type="radio" name="calidad_servicio" id="calidad_servicio" value="Excelente">
			</span>
			<label class="form-control input-sm">Excelente</label>
		</div>
	</div>
	<div class="col-md-12">
		<div class="input-group ">
			<span class="input-group-addon input-sm">
				<input type="radio" name="calidad_servicio" id="calidad_servicio" value="Bueno">
			</span>
			<label class="form-control input-sm">Bueno</label>
		</div>
	</div>
	<div class="col-md-12">
		<div class="input-group">
			<span class="input-group-addon input-sm">
				<input type="radio" name="calidad_servicio" id="calidad_servicio" value="Regular">
			</span>
			<label class="form-control input-sm">Regular</label>
		</div>
	</div>
	<div class="col-md-12">
		<div class="input-group">
			<span class="input-group-addon input-sm">
				<input type="radio" name="calidad_servicio" id="calidad_servicio" value="Malo">
			</span>
			<label class="form-control input-sm">Malo</label>
		</div>
	</div>
</div>

				</div>
			  </div>
			  <div class="form-group">
				<label for="user_perfil" class="col-sm-3 control-label">Trato del Personal</label>
				<div class="col-sm-8">

					<div class="row">
	<div class="col-md-12">
		<div class="input-group ">
			<span class="input-group-addon input-sm">
				<input type="radio" name="trato_personal" id="trato_personal" value="Excelente">
			</span>
			<label class="form-control input-sm">Excelente</label>
		</div>
	</div>
	<div class="col-md-12">
		<div class="input-group ">
			<span class="input-group-addon input-sm">
				<input type="radio" name="trato_personal" id="trato_personal" value="Bueno">
			</span>
			<label class="form-control input-sm">Bueno</label>
		</div>
	</div>
	<div class="col-md-12">
		<div class="input-group">
			<span class="input-group-addon input-sm">
				<input type="radio" name="trato_personal" id="trato_personal" value="Regular">
			</span>
			<label class="form-control input-sm">Regular</label>
		</div>
	</div>
	<div class="col-md-12">
		<div class="input-group">
			<span class="input-group-addon input-sm">
				<input type="radio" name="trato_personal" id="trato_personal" value="Malo">
			</span>
			<label class="form-control input-sm">Malo</label>
		</div>
	</div>
</div>


				</div>
			  </div>
			  <div class="form-group">
				<label for="observaciones" class="col-sm-3 control-label">Observaciones</label>
				<div class="col-sm-8">
				  <textarea type="text" placeholder="Ingrese Observaciones" class="form-control input-sm"  name="observaciones" rows="3"></textarea>
				</div>
			  </div>
<div class="col-md-12">

		                <div class="form-group">

								<input class='filestyle' data-buttonText="Imagen" type="file" name="imagefile" id="imagefile" required>
						</div>

</div>




			 <div class='col-md-12' id="resultados_ajax"></div>

		  </div>
		  <div class="modal-footer">

			<button type="button" class="btn btn-default" data-dismiss="modal">Cerrar</button>
			 <button type="submit" class="btn btn-sm btn-success" id="guardar_datos"><i class="glyphicon glyphicon-floppy-disk"></i> Registrar Encuesta</button>
		  </div>
		  </form>
		</div>
	  </div>
	</div>
	<?php
		}
	?>