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

@section('title', '| Pour-Over Will Form')

@section('content')
@include('frontend.forms.v2.Living-Will.stepIndicator')
 <!-- start -->

   <form action="{{route('LivingWillFormStore')}}" method="POST" id="signUpForm" class="multiple-form">
      @csrf
      <input type="hidden" id="stepInput" name="step" value="1">



      <div class="multiple-form dashboard-radio">
         <h5 style="text-transform: none;">Create your Living Will</h5>
         <p>Do you want to appoint someone to make your health care decisions if you are unable to?</p>

         <div class="form">
            <div class="row">
               <div class="col-12">
                  <div class="dashboard-radio-form">
                        <div class="form-check">
                           <input class="form-check-input" id="livingwill-y" name="livingwill" value="yes" type="radio" {{ isset($livingWillForm->health_care_decisions) &&  $livingWillForm->health_care_decisions == "yes" ? 'checked' : ''}}>
                           <label for="livingwill-y">
                                 <p>Yes</p>
                                 
                           </label>
                        </div>
                        <div class="form-check">
                           <input class="form-check-input" id="livingwill-n" name="livingwill" value="no" type="radio" {{ isset($livingWillForm->health_care_decisions) &&  $livingWillForm->health_care_decisions == "no" ? 'checked' : ''}}>
                           <label for="livingwill-n">
                                 <p>No</p>
                           </label>
                        </div>
                  </div>
               </div>
            </div>
         </div>
      </div>


      <!-- start previous / next buttons -->
      <div class="submit-button-multiple align-items-center justify-content-center">

            <button type="button" class="d-none">Back</button>
            <button type="submit" class="submit-btn">Save and Continue</button>
         
            <button type="submit" name="preview_submit" class="d-none" value="preview">{{env('PREVIEW_BUTTON_TEXT')}}</button>
            <button type="button" class="skip-btn d-none">Skip Step</button>
      
      </div>
      <!-- end previous / next buttons -->

   </form>
 
</div>

@endsection
@section('page-js')
<script src="{{ url('frontend/assets/js/forms/living-will-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