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

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

@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="2">
      <div class="multiple-form dashboard-radio">
        <h4>Location</h4>
        <div class="form-group mt-5">
          <label>What state do you live in?</label>
          <input type="text" value="{{ isset($livingWillForm->live_state) ? $livingWillForm->live_state : ''}}" name="live_state" id="live_state" aria-describedby="stateHelp" >
        </div>
      </div>
      <!-- start previous / next buttons -->
      <div class="submit-button-multiple">
        
          @if($livingWillForm->health_care_decisions == "yes")
          <button type="button" onclick="window.location.href = '{{ route('livingwill.create.step.one_1') }}'">Back</button>
          @elseif($livingWillForm->health_care_decisions == "no")
          <button type="button" onclick="window.location.href = '{{ route('livingwill.create.step.one') }}'">Back</button>
          @endif
          <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>

@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