@extends('layouts.frontlayout')
@section('content')

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<section class="breadcamee_section top-space">
    <div class="container">
        <div class="row align-items-center">
            <div class="col-xxl-12 col-xl-12 col-lg-12 col-md-12 col-sm-12 col-12">
                <div class="banner_area">
                   <div class="banner_image">
                       <h1>SANDY</h1>
                    </div>
                    <div class="heading_area">
                        <p>Home / Nutritional Advisor Form</p>
                        <h1>Nutritional Advisor Form</h1>
                    </div>
                </div>
            </div>
        </div>
    </div>
</section>
<!-- ==== Breadcame_section_end ==== -->

<!-- ==== Progress_bar_section_start ==== -->
<section class="progress_bar_section">
    <div class="container">
        <div class="row">
            <div class="col-xxl-12 col-xl-12 col-lg-12 col-md-12 col-sm-12 col-12">
                <div class="inner_area">
                    <div class="heading_area">
                        <h4>Risk stratification screening tool (RSST)</h4>
                    </div>
                    <div class="row">
                        <div class="col-xxl-8 col-xl-8 col-lg-8 col-md-10 col-sm-12 col-12 mx-auto">
                        <div class="progress_bar_area">
                            <div class="line_bar">
                                <div class="bar_inn" style="width:100%;"></div>
                                    <div class="bar_wrap">
                                        <div class="bar_circle circle_1 form_3"></div>
                                        <div class="bar_circle circle_2 form_3"></div>
                                        <div class="bar_circle circle_3 form_3"></div>
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</section>
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<!-- ==== Form_section_start ==== -->
<section class="form_section">
    <div class="container">
        <div class="row">
            <div class="col-xxl-12 col-xl-12 col-lg-12 col-md-12 col-sm-12 col-12">
                <div class="row">
                    <div class="col-xxl-8 col-xl-8 col-lg-8 col-md-10 col-sm-12 col-12 mx-auto">
                        <div class="form_area">
                            @include('user.partials.flash_messages')
                            <form method="post" class="advisory_form form-validation" novalidate="novalidate">
                               {{ @csrf_field() }}
                                <div class="form-group">
                                    <label class="form-label">Is your BMI below 18.5kg/m2 (40)?</label>
                                    <input type="text" name="bmi" class="form-control" value="{{ isset($row->bmi) && $row->bmi ? $row->bmi : @old('bmi') }}" required>
                                    <label id="bmi-error" class="error" for="bmi">@error('bmi') {{ $message }} @enderror</label>
                                </div>
                                <div class="form-group">
                                    <label class="form-label">Have you been diagnosed with any conditions impacting 
                                        fertility (i.e. polycystic ovarian syndrome, endometriosis)? If yes, please indicate below:</label>
                                    <input type="text" name="fertility_diagnosed" value="{{ isset($row->fertility_diagnosed) && $row->fertility_diagnosed ? $row->fertility_diagnosed : @old('fertility_diagnosed') }}" class="form-control" required>
                                    <label id="fertility_diagnosed-error" class="error" for="fertility_diagnosed">@error('fertility_diagnosed') {{ $message }} @enderror</label>
                                </div>
                                <div class="form-group">
                                    <label class="form-label">Have you been formally diagnosed with any food allergies and/ or intolerances? 
                                        If yes, please specify food allergy, diagnostic tool and an approximate diagnosis date:</label>
                                    <input type="text" name="formally_diagnosed" value="{{ isset($row->formally_diagnosed) && $row->formally_diagnosed ? $row->formally_diagnosed : @old('formally_diagnosed') }}" class="form-control" required>
                                    <label id="formally_diagnosed-error" class="error" for="formally_diagnosed">@error('formally_diagnosed') {{ $message }} @enderror</label>
                                </div>
                                <div class="form-group">
                                    <label class="form-label">Have you been formally diagnosed with a mental health condition 
                                        in which you are required to take medication? </label>
                                    <input type="text" name="mental_diagnosed" value="{{ isset($row->mental_diagnosed) && $row->mental_diagnosed ? $row->mental_diagnosed : @old('mental_diagnosed') }}" class="form-control" required>
                                    <label id="mental_diagnosed-error" class="error" for="mental_diagnosed">@error('mental_diagnosed') {{ $message }} @enderror</label>
                                </div>
                                <div class="form-group">
                                    <label class="form-label">Do you experience bloating regularly? <span class="text-danger">*</span>
                                    </label>
                                    <div class="custom-control-radio custom-radio">
                                        <input class="form-check-input" type="radio" name="bloating" id="r-1" value="yes" @if(isset($row->bloating) && $row->bloating == 'yes') checked @endif required>
                                        <label class="form-check-label" for="r-1">
                                        Yes 
                                        </label>
                                        <input class="form-check-input" type="radio" name="bloating" id="r-2" value="no" @if(isset($row->bloating) && $row->bloating == 'no') checked @endif required>
                                        <label class="form-check-label" for="r-2">
                                        No 
                                        </label>
                                    </div>
                                    <label id="bloating-error" class="error" for="bloating">@error('bloating') {{ $message }} @enderror</label>
                                </div>
                                <div class="form-group">
                                    <label class="form-label">Do you believe you suffer from low energy levels? 
                                        If yes, please provide more information below: </label>
                                    <input type="text" name="low_energy" value="{{ isset($row->low_energy) && $row->low_energy ? $row->low_energy : @old('low_energy') }}" class="form-control" required>
                                    <label id="low_energy-error" class="error" for="low_energy">@error('low_energy') {{ $message }} @enderror</label> 
                                </div>
                                <div class="form-group">
                                    <label class="form-label">Do you suspect you may have any food allergies and/ or intolerances? If yes, 
                                        please identify why you think you may have an allergy/ intolerance and to what specific food:  </label>
                                    <input type="text" name="food_allergies" value="{{ isset($row->food_allergies) && $row->food_allergies ? $row->food_allergies : @old('food_allergies') }}" class="form-control" required>
                                    <label id="food_allergies-error" class="error" for="food_allergies">@error('food_allergies') {{ $message }} @enderror</label>
                                </div>
                                <div class="form-group">
                                    <div class="custom-control custom-checkbox">
                                        <input type="checkbox" class="custom-control-input" name="agree" id="l-1" value="1" required>
                                        <label class="custom-control-label" for="l-1">I Agree</br>
                                            Consent for Nutritional Counselling I hereby request and consent to SandyFitnessCoach (Sandy Singh) 
                                            providing Nutrition Counselling to myself or the client for which I am legally responsible.
                                            I understand that the consultant will provide information and guidance about my diet, nutrition,
                                            and lifestyle. I understand that Sandy Singh is a Nutrition Advisor and he does not dispense 
                                            medical advice, nor will he diagnose or treat any medical condition. Methods of nutritional 
                                            evaluation or testing made available to me are not intended to diagnose disease. Rather, these 
                                            assessments are intended as a guide to enhancing my nutritional health and supporting the 
                                            achievement of my athletic goals. We use cookies to ensure that we give you the best experience
                                            on our website. If you continue to use this site we will assume that you are happy with it.
                                        </label>
                                    </div>
                                    <label id="agree-error" class="error" for="agree">@error('agree') {{ $message }} @enderror</label>
                                </div>
                                <div class="button_area">
                                    <div class="left">
                                        <a href="{{ route('mutritionalAdvisor.form2', ['step_2' => $_GET['step_3']]) }}" class="btn btn-primary-8">Back</a>
                                    </div>
                                    <div class="right">
                                         <button type="submit" class="btn btn-primary-3" > Submit</button>
                                    </div>
                                </div>
                            </form>
                        </div>
                    </div>
                </div>
            </div>
        </div>
    </div>
</section>                    
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@endsection