@extends('layouts.frontend')

@section('title', '| Free Living Will')

@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="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">Location</div>
                   <div class="form-group mb-3">
                     <label for="name">What state do you live in?</label>
                     <input type="text" class="form-control modified-input" value="{{ isset($livingWillForm->live_state) ? $livingWillForm->live_state : ''}}" name="live_state" aria-describedby="stateHelp" placeholder="Location">
                   </div>
                 </div>
               </div>
           </div>
            <!-- start previous / next buttons -->
            <div id="buttonsection">
               <div class="form-footer d-flex justify-content-between">
                  <div>
                  @if($livingWillForm->health_care_decisions == "yes")
                  <button type="button" onclick="window.location.href = '{{ route('livingwill.create.step.one_1') }}'" class="btn btn-light btn-lg back-btn">Back</button>
                  @elseif($livingWillForm->health_care_decisions == "no")
                  <button type="button" onclick="window.location.href = '{{ route('livingwill.create.step.one') }}'" class="btn btn-light btn-lg back-btn">Back</button>
                  @endif
                  <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/living-will-multi-step.js?v=10.1') }}"></script>
<script src="{{ url('frontend/assets/js/forms/custom.js?v=10.3') }}"></script>

@endsection