@extends('layouts.v2.frontend-user-backend')

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

@section('content')
@include('frontend.forms.v2.End-Of-Life-Plan.stepIndicator')
    <form action="{{route('EndoflifePlanFormStore')}}" method="POST" id="signUpForm">
      @csrf
      <input type="hidden" id="stepInput" name="step" value="5-f-2">
      <div class="multiple-form dashboard-radio">
         <h4>Funeral location</h4>
         <p>Where will your funeral be held?</p>

         <div class="form">
            <div class="row">
               <div class="col-12">
                  @php
                        $visitation_location = json_decode($endoflifePlanForm->funeral_location, true);
                  @endphp
                  <div class="form-group mb-3">
                     <label for="name">Name:</label>
                     <input type="text"  value="{{isset($visitation_location['full_name']) ? $visitation_location['full_name'] : '' }}" name="full_name" id="full_name" aria-describedby="nameHelp">
                     <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"  id="address" name="address" aria-describedby="addressHelp" 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>
         <!-- start previous / next buttons -->
         <div id="buttonsection" class="submit-button-multiple">
            <button type="button" onclick="window.location.href = '{{ route('endoflifePlan.create.step.five_funeral-1') }}'">Back</button>
            <button type="submit" class="submit-btn">Save and Continue</button>
            <button type="submit" class="d-none" name="preview_submit" value="preview">{{env('PREVIEW_BUTTON_TEXT')}}</button>
            <button type="button" class="skip-btn d-none">Skip Step</button>
         </div>
         <!-- end previous / next buttons -->
      </div>
    </form>
@endsection
@section('page-js')
<script src="{{ url('frontend/assets/js/forms/end-of-life-plan-multi-step.js') }}?v={{ time() }}"></script>
<script src="{{ url('frontend/assets/js/forms/custom.js?v=10.3') }}"></script>
<script src="{{ url('v2/js/form-validation.js') }}?v={{ time() }}"></script>

@endsection