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

@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.v2.Living-Will.stepIndicator')
 <!-- start -->
<div class="container">
    <form action="{{route('LivingWillFormStore')}}" method="POST" id="signUpForm" class="multiple-form">
      @csrf
      <input type="hidden" id="stepInput" name="step" value="6-1">
      <div class="multiple-form dashboard-radio">
         <h4>Signing details</h4>
         <p>When will this document be signed?</p>
         <div class="form">

            <div class="dashboard-radio-form"> 
               <div class="form-check">
                  <input id="dunsure" class="form-check-input" name="s_d" type="radio" value="unsure" {{ isset($signing_details['signing']) &&  $signing_details['signing'] == "unsure" ? 'checked' : ''}}>
                  <label for="dunsure"  id="dunsure">
                     <p>Unsure</p>
                  </label>
               </div>
               <div class="form-check">
                  <input id="sd" name="s_d" class="form-check-input" type="radio" value="specifydate" {{ isset($signing_details['signing']) &&  $signing_details['signing'] == "specifydate" ? 'checked' : ''}}>
                  <label for="sd" id="sd">
                     <p>Specify date</p>
                  </label>
               </div>
            </div>

            <div class="row mt-5">
               <div id="specify_date_holder" class="form-group mb-3">
                  <label for="date">Date</label>
                  <input type="text" 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="sub-title">Which city/town will you sign your Living Will in?</div>
               <div class="form-group my-3">
                  <label for="city">City/Town</label>
                  <input type="text" name="sl_city" id="sl_city"  value="{{ isset($signing_details['city']) ? $signing_details['city'] : '' }}" >
               </div>
            </div>

         </div>
      </div>

      <!-- start previous / next buttons -->
      <div class="submit-button-multiple">
         <button type="button" onclick="window.location.href = '{{ route('livingwill.create.step.six') }}'">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 class="faq-box d-none">
      <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> 


@endsection
@section('page-js')
<script src="https://code.jquery.com/ui/1.13.2/jquery-ui.js"></script>
<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