@extends('layouts.frontend')

@section('title', '| Free Living Will')
@section('css')
<link rel="stylesheet" href="//code.jquery.com/ui/1.13.2/themes/base/jquery-ui.css">
@endsection
@section('content')
@include('frontend.forms.Living-Will.stepIndicator')
 <!-- start -->
<div class="container">
    <form action="{{route('LivingWillFormStore')}}" method="POST" id="signUpForm">
      @csrf
      <input type="hidden" id="stepInput" name="step" value="6-1">
      <div class="card">
         <div class="card-body">
            <!-- step 1 -->
            <div class="step" style="display: block">
               <div class="row">
                 <div class="col-md-10 col-lg-8 order-1 order-md-1 order-lg-1">
                   <div class="card-title">Signing Details</div>
                   <div class="card-sub-title">When will this document be signed?</div>
                   <div class="custom-m-status">
                     <input id="dunsure" name="s_d" type="radio" value="unsure" {{ isset($signing_details['signing']) &&  $signing_details['signing'] == "unsure" ? 'checked' : 'checked'}}>
                     <label for="dunsure" class="marital-box" id="dunsure">
                        <p>Unsure</p>
                     </label>
                     <input id="sd" name="s_d" type="radio" value="specifydate" {{ isset($signing_details['signing']) &&  $signing_details['signing'] == "specifydate" ? 'checked' : ''}}>
                     <label for="sd" class="marital-box" id="sd">
                        <p>Specify date</p>
                     </label>
                   </div>
 
                   <div id="specify_date_holder" class="form-group mb-3">
                     <label for="date">Date</label>
                     <input type="text" class="form-control modified-input" name="specify_date" id="specify_date" value="{{ isset($signing_details['date']) ? $signing_details['date'] : date('Y-m-d') }}" placeholder="mm-dd-yy">
                   </div>
          
 
                  <div class="card-sub-title">Which city/town will you sign your Living Will in?</div>
                  <div class="form-group mb-3">
                     <label for="city">City/Town</label>
                     <input type="text" class="form-control modified-input" name="sl_city" id="sl_city" placeholder="City/Town" value="{{ isset($signing_details['city']) ? $signing_details['city'] : '' }}">
                   </div>
                 </div>
                  <div class="col-md-8 col-lg-4 order-3 order-md-3 order-lg-2">
                     <div class="faq-box">
                        <div class="title">Frequently Asked Questions</div>
                        <div class="tooltip">
                              <p>What if I want to sign in a different state?</p>
                              <span class="tooltiptext">If you want to create or update your estate planning documents in a different state from where you currently reside, it's advisable to consult with an attorney licensed in that State. Laws related to estate planning can vary, so it is crucial to ensure your documents comply with the laws of the State where you intend to sign them.</span>
                        </div>
                     </div> 
                  </div>
                  <!-- start previous / next buttons -->
                  <div class="col-md-12 order-2 order-md-2 order-lg-3">
                     <div id="buttonsection">
                        <div class="form-footer d-flex justify-content-between">
                        <div>
                           <button type="button" onclick="window.location.href = '{{ route('livingwill.create.step.six') }}'" 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>
                  </div>
                  <!-- end previous / next buttons -->
               </div>
            </div>
         </div>
      </div>
</div>

@endsection
@section('page-js')
<script src="{{ url('frontend/assets/js/forms/living-will-multi-step.js?v=10.1') }}"></script>
<script src="{{ url('frontend/assets/js/forms/custom.js?v=10.3') }}"></script>
<script src="https://code.jquery.com/ui/1.13.2/jquery-ui.js"></script>
<script>
    $(function() {
       $( "#specify_date" ).datepicker({
          changeMonth: true, // Allow changing of month
          changeYear: true, // Allow changing of year
          dateFormat: 'mm-dd-yy', // Set the desired date format
          yearRange: "-200:+0", // Set range of selectable years
          maxDate: new Date() // Prevent selecting future dates
       });
    });
 </script>
@endsection