@extends('layouts.frontend')

@section('title', '| FREE END-OF-LIFE PLAN')

@section('content')
@include('frontend.forms.End-Of-Life-Plan.stepIndicator')
 <!-- start -->
<div class="container">
    <form action="{{route('EndoflifePlanFormStore')}}" method="POST" id="signUpForm">
      @csrf
      <input type="hidden" id="stepInput" name="step" value="5-v-2">
      <div class="card">
         <div class="card-body">
            <!-- step 1 -->
            <div class="step" style="display: block">
               <div class="row">
                  <div class="col-md-8">
                     <div class="card-title">Visitation Location</div>
                     <div class="card-sub-title">Where will your visitation be held?</div>
                     @php
                          $visitation_location = json_decode($endoflifePlanForm->visitation_location, true);
                     @endphp
                     <div class="form-group mb-3">
                        <div class="form-group mb-3">
                           <label for="name">Name:</label>
                           <input type="text" class="form-control modified-input" value="{{isset($visitation_location['full_name']) ? $visitation_location['full_name'] : '' }}" name="full_name" aria-describedby="nameHelp" placeholder="Full Name">
                           <small id="nameHelp" class="form-text text-muted">e.g. Kendrick Funeral Home, my home</small>
                        </div>
                        <div class="form-group mb-3">
                           <label for="city">Address:</label>
                           <input type="text" class="form-control modified-input" name="address" aria-describedby="addressHelp" placeholder="City/Town" value="{{isset($visitation_location['address']) ? $visitation_location['address'] : '' }}">
                           <small id="addressHelp" class="form-text text-muted">e.g. Street, City, State ZIP Code</small>
                        </div>
                     </div>
                  </div>
               </div>
            </div>
            <!-- start previous / next buttons -->
            <div id="buttonsection">
               <div class="form-footer d-flex justify-content-between">
                  <div>
                  <button type="button" onclick="window.location.href = '{{ route('endoflifePlan.create.step.five_visitation-1') }}'" class="btn btn-light btn-lg back-btn">Back</button>
                  <button type="submit" class="btn btn-light btn-lg">Save and Continue</button>
               </div>
               <button type="submit" class="btn btn-light btn-lg" name="preview_submit" value="preview">{{env('PREVIEW_BUTTON_TEXT')}}</button>
                  <button type="button" class="btn btn-light btn-lg skip-btn d-none">Skip Step</button>
               </div>
            </div>
            <!-- end previous / next buttons -->
         </div>
      </div>
</div>

@endsection
@section('page-js')
<script src="{{ url('frontend/assets/js/forms/end-of-life-plan-multi-step.js?v=10.1.1') }}"></script>
<script src="{{ url('frontend/assets/js/forms/custom.js?v=10.3') }}"></script>

@endsection