<select class="field" name="category">
<option>Клиника</option>
<option value="2">Частный врач</option>
</select>
<div class="modal fade" id="modalRegister" tabindex="-1" role="dialog" aria-labelledby="modalAnswer">
<div class="modal-dialog modal-dialog__bordered" role="document">
<div class="modal-content modal-content">
<div class="modal-body">
<button type="button" class="modal-close" data-dismiss="modal" aria-label="Закрыть"><span aria-hidden="true">×</span></button>
<form class="form jq-register-form" method="post" action="?send=Y">
<h3 class="form_heading heading">Регистрация</h3>
<div class="form_row">
<label class="form_label">Категория:</label>
<select class="field" name="category">
<option>Клиника</option>
<option value="2">Частный врач</option>
</select>
</div>
<div class="jq-content">
<div class="form_row">
<input class="field" type="text" placeholder="Название клиники" name="name" required>
</div>
<div class="form_row">
<textarea class="field field__textarea" placeholder="Описание" name="description"></textarea>
</div>
<div class="form_row">
<input class="field" type="email" placeholder="Электронная почта" name="email" required>
</div>
<div class="form_row">
<input class="field" placeholder="Регион:" type="text" name="region">
</div>
<div class="form_row">
<div id="reCaptcha1"></div>
</div>
</div>
<button class="main-btn" type="submit" name="register_submit" value="Y"><span class="icon icon-forum"></span> Отправить</button>
</form>
</div>
</div>
</div>
</div>
<script type="text/javascript">
$('.jq-register-form').on('change', '[name="category"]', function(){
if ($(this).val() == 2) {
$('.jq-register-form .jq-content').html(
'<div class="form_row">'+
'<label class="form_label">Ф.И.О.: <span style="color: red;">*</span></label>' +
'<input class="field" type="text" name="name" required>' +
'</div>' +
'<div class="form_row">'+
'<label class="form_label">Профессия: <span style="color: red;">*</span></label>' +
'<input class="field" type="text" name="job" required>' +
'</div>' +
'<div class="form_row">' +
'<label class="form_label">Опыт: <span style="color: red;">*</span></label>' +
'<textarea class="field field__textarea" name="exp" require></textarea>' +
'</div>' +
'<div class="form_row">' +
'<label class="form_label">Специализация: <span style="color: red;">*</span></label>' +
'<textarea class="field field__textarea" name="spec" require></textarea>' +
'</div>' +
'<div class="form_row">' +
'<label class="form_label">Адрес клиники: <span style="color: red;">*</span></label>' +
'<textarea class="field field__textarea" name="address" require></textarea>' +
'</div>' +
'<div class="form_row">' +
'<label class="form_label">Ваш e-mail: <span style="color: red;">*</span></label>' +
'<input class="field" type="email" name="email" required>' +
'</div>' +
'<div class="form_row">'+
'<label class="form_label">Телефон (для связи администрации сайта с врачом, не публикуется на сайте): </label>' +
'<input class="field" type="text" name="phone">' +
'</div>' +
'<div class="form_row">' +
'<label class="form_label">Регион:</label>' +
'<input class="field" type="text" name="region">' +
'</div>' +
'<div class="form_row">' +
'<label class="form_label">Дополнительная информация: </label>' +
'<textarea class="field field__textarea" name="opt"></textarea>' +
'</div>'
);
}
else {
$('.jq-register-form .jq-content').html(
'<div class="form_row">'+
'<label class="form_label">Название: <span style="color: red;">*</span></label>' +
'<input class="field" type="text" name="name" required>' +
'</div>' +
'<div class="form_row">' +
'<label class="form_label">Описание: <span style="color: red;">*</span></label>' +
'<textarea class="field field__textarea" name="description"></textarea>' +
'</div>' +
'<div class="form_row">' +
'<label class="form_label">Ваш e-mail: <span style="color: red;">*</span></label>' +
'<input class="field" type="email" name="email" required>' +
'</div>' +
'<div class="form_row">' +
'<label class="form_label">Регион:</label>' +
'<input class="field" type="text" name="region">' +
'</div>'
);
}
});
</script>