public function process() {
- $this->pre_process();
+ //$this->pre_process();
$headers = [];
$data = [];
$to = $this->destination;
- $from = 'CCV Montpellier <no-reply@ccv-montpellier.fr>';
+ $from = 'Spine pro <no-reply@spinepro.fr>';
$subject = $this->form_title;
$content_type = 'text/html';
$charset = get_bloginfo('charset');
// Gather filled fields into label/value pairs
foreach ($this->fields as $field_name => $field) {
- if ($value = $this->get_data($field_name)) {
- $data[$field->get_title()] = $value;
+ if(!in_array($field_name,['years','months'])) {
+ if ($value = $this->get_data($field_name)) {
+ $data[$field->get_title()] = $value;
+ }
}
}
+ $data['How long have you been suffering ?'] = 'Years: '.$this->get_data('years').' - Months: '.$this->get_data('months');
+
$message = view('forms.common.email', compact('data', 'subject'));
// Hook directly into WPMailer temporarily so we can add attachments and set their proper filenames
$this->add_fields([
//=== PERSONAL INFORMATION
- Text::field('last-name', __('Nom', 'Nom de famille', 'ccv')),
- Text::field('first-name', __('Prénom', 'ccv')),
+ Text::field('name', __('Name', 'ccv')),
Text::field('profession', __('Profession', 'ccv')),
+ Text::field('address', __('Address', 'ccv')),
Text::field('postcode', __('Code postal', 'ccv')),
Text::field('city', __('Ville', 'ccv')),
Text::field('country', __('Pays', 'ccv')),
Text::field('phone', __('Tel', 'ccv')),
- Email::field('email', __('Email', 'ccv')),
- Radio::field('sex', __('Sexe', 'ccv'))
+ Email::field('email', __('Email address', 'ccv')),
+ Radio::field('sexe', __('Sexe:', 'ccv'))
->options([
_x('M', 'Sexe (M)', 'ccv'),
_x('F', 'Sexe (F)', 'ccv'),
]),
+ Radio::field('contact_preference', __('Contact preference:', 'ccv'))
+ ->options([
+ _x('Email', 'Email', 'ccv'),
+ _x('Phone', 'Phone', 'ccv'),
+ ]),
Text::field('age', __('Âge :', 'ccv')),
- Textarea::field('message', __('Avez vous un message (ou une demande) spécifique à nous formuler ?', 'ccv'))->required(false),
-
- // Special field: if a surgeon is selected, their e-mail address will be override the default delivery address
- Select::field('surgeon', __('Chirurgien spécifique', 'ccv'))
- ->required(false)
- ->options([
- 'Dr Guilhaume GENESTE' => 'dr.geneste@ccv-montpellier.fr',
- 'Dr Grégory EDGARD-ROSA' => 'dr.edgard-rosa@ccv-montpellier.fr',
- 'Dr Martin GRAU ORTIZ' => 'dr.grauortiz@ccv-montpellier.fr',
- 'Dr Caroline HIRSH' => 'dr.hirsch@ccv-montpellier.fr',
- ]),
-
- //=== IMAGERY
- // This is a special case and will be output manually so only using this for the e-mail label
- Radio::field('imagery-type', __('Imagerie', 'ccv'))->required(false),
- Textarea::field('imagery-online', __('Images en ligne', 'ccv'))->required(false), // Again, a manually handled field
- Checkbox::field('imagery-posted', __('Images envoyées par courrier', 'ccv'))->required(false),
-
- // Unique session identifier for uploads that go directly to CCV's NAS (upload.ccv-montpellier.fr)
- // Made up of timestamp YYMMDDHHMM + nonce
- Hidden::field('imagery-phone-token', __('ID sur le NAS', 'ccv'))->value(date('ymdHi') . '_' . wp_create_nonce('NAS-upload')),
+ Text::field('occupation', __('Occupation', 'ccv')),
+ Text::field('nationality', __('Nationality', 'ccv')),
+ Date::field('birthdate', __('Date of birth:', 'ccv')),
//== SYMPTOMS
- Radio::field('main-problem', __('Problème principal', 'ccv'))
- ->options([
- __('Cervicales', 'ccv'),
- __('Lombaires', 'ccv'),
- __('Scoliose', 'ccv'),
- ]),
-
- Date::field('date-first-symptoms', __('Date des premiers symptômes :', 'ccv')),
-
- Date::field('date-pain-since', __('Douleurs permanentes depuis (le cas échéant) :', 'ccv'))->required(false),
-
- Binary::field('pain-arms-legs', __('Avez-vous des douleurs dans les bras ou les jambes (sciatiques, cruralgies, névralgies) ?', 'ccv')),
-
- Checkbox::field('pain-arms-legs-detail', __('Si oui, cochez les membres concernés :', 'ccv'))
- ->required(false)
- ->options([
- __('Haut du bras droit', 'ccv'),
- __('Haut du bras gauche', 'ccv'),
- __('Avant-bras droit', 'ccv'),
- __('Avant-bras gauche', 'ccv'),
- __('Haut de la jambe droite', 'ccv'),
- __('Haut de la jambe gauche', 'ccv'),
- __('Bas de la jambe droite', 'ccv'),
- __('Bas de la jambe gauche', 'ccv'),
- ]),
-
- Radio::field('main-pain', __('La douleur principale est-elle ?', 'ccv'))
+ Radio::field('lumbar-dic-disease', __('Have you been diagnosed with lumbar/degenerative disc disease?', 'ccv'))
->options([
- __('Dans la colonne', 'ccv'),
- __('Dans les membres', 'ccv'),
- __('Les deux', 'ccv'),
+ __('Yes', 'ccv'),
+ __('No', 'ccv'),
]),
- Binary::field('tingling-numbness', __('Avez-vous des fourmillements ou une sensation d’engourdissement dans un des membres ? ', 'ccv')),
- Date::field('tingling-numbness-date', __('Si oui depuis quand ?', 'ccv'))->required(false),
-
- Binary::field('strength-loss', __('Avez-vous une perte de force importante dans un des membres ?', 'ccv')),
- Date::field('strength-loss-date', __('Si oui depuis quand ?', 'ccv'))->required(false),
-
- //=== TREATMENTS
- Textarea::field('medication', __('Indiquez ici les médicaments que vous avez pris pour vos douleurs (le cas échéant)', 'ccv'))->required(false),
- Binary::field('kine-osteo', __('Kinésithérapie ou ostéopathie', 'ccv')),
- Binary::field('corset', __('Corset ou ceinture lombaire', 'ccv')),
- Binary::field('hospitalisation', __('Séjour en hospitalisation', 'ccv')),
- Binary::field('infiltration', __('Infiltration ou thermocoagulation', 'ccv')),
- Textarea::field('surgeries', __('Indiquez ici vos précédentes chirurgies de la colonne et leurs dates (le cas échéant)', 'ccv'))->required(false),
-
+ Radio::field('chronic-pain', __('Are you suffering with (chronic) back pain and sciatica?', 'ccv'))
+ ->options([
+ __('Yes', 'ccv'),
+ __('No', 'ccv'),
+ ]),
+
+ Text::field('years', __('Years', 'ccv')),
+ Text::field('months', __('Months', 'ccv')),
+
+ Radio::field('lumbar-mri-scan', __('Do you have a recent Lumbar MRI scan?', 'ccv'))
+ ->options([
+ __('Yes', 'ccv'),
+ __('No', 'ccv'),
+ ]),
+
+ Radio::field('cortisone-injection', __('Have you been offered or undergone treatment such as Cortisone injections, discectomy, spinal fusion or other therapy?', 'ccv'))
+ ->options([
+ __('Yes', 'ccv'),
+ __('No', 'ccv'),
+ ]),
+
+ Radio::field('ready-for-surgery', __('Are you ready for surgery to permanently cure your condition?', 'ccv'))
+ ->options([
+ __('Yes', 'ccv'),
+ __('No', 'ccv'),
+ ]),
+
+ Radio::field('willing-to-travel', __('Are you willing to travel to Montpellier, France? Your stay would be, typically, 9 days in total.', 'ccv'))
+ ->options([
+ __('Yes', 'ccv'),
+ __('No', 'ccv'),
+ ]),
+
+ Radio::field('able-to-self-fund', __('Are you able to self-fund the treatment? Typical costs are £36,000.', 'ccv'))
+ ->options([
+ __('Yes', 'ccv'),
+ __('No', 'ccv'),
+ ]),
]);
}
- public function pre_process() {
+ /*public function pre_process() {
// Include patient name in subject line
$this->set_form_title(' - ' . strtoupper($this->get_data('last-name')) . ', ' . $this->get_data('first-name'), true);
$this->set_destination($surgeons[$this->get_data('surgeon')]);
}
}
- }
+ }*/
}
opacity: 1;
}
+.header-slideshow .header-slideshow-content.showing .header-slideshow-title,
+.header-slideshow .header-slideshow-content.showing .header-slideshow-body {
+ opacity: 1;
+}
+
.header-slideshow .header-slideshow-content:before {
content: none;
}
visibility: visible;
}
+.header-slideshow-title,
+.header-slideshow-body {
+ opacity: 0;
+ transition: opacity 1s;
+}
+
.header-slideshow-title {
display: block;
font-size: 1.333em;
border-left: 0;
}
-.flatpickr-calendar.showTimeInput.hasTime .flatpickr-time {
+.flatpickr-calendar.hasTime .flatpickr-time {
height: 40px;
border-top: 1px solid #e6e6e6;
}
-.flatpickr-calendar.showTimeInput.hasTime .flatpickr-innerContainer {
+.flatpickr-calendar.hasTime .flatpickr-innerContainer {
border-bottom: 0;
}
-.flatpickr-calendar.showTimeInput.hasTime .flatpickr-time {
+.flatpickr-calendar.hasTime .flatpickr-time {
border: 1px solid #e6e6e6;
}
}
.flatpickr-calendar.rightMost:before,
-.flatpickr-calendar.rightMost:after {
+.flatpickr-calendar.arrowRight:before,
+.flatpickr-calendar.rightMost:after,
+.flatpickr-calendar.arrowRight:after {
left: auto;
right: 22px;
}
+.flatpickr-calendar.arrowCenter:before,
+.flatpickr-calendar.arrowCenter:after {
+ left: 50%;
+ right: 50%;
+}
+
.flatpickr-calendar:before {
border-width: 5px;
margin: 0 -5px;
}
.flatpickr-calendar.arrowTop:after {
- border-bottom-color: #ff078b;
+ border-bottom-color: #1d7aea;
}
.flatpickr-calendar.arrowBottom:before,
}
.flatpickr-calendar.arrowBottom:after {
- border-top-color: #ff078b;
+ border-top-color: #1d7aea;
}
.flatpickr-calendar:focus {
.flatpickr-months .flatpickr-month {
border-radius: 5px 5px 0 0;
- background: #ff078b;
+ background: #1d7aea;
color: #fff;
fill: #fff;
height: 34px;
.flatpickr-months .flatpickr-prev-month,
.flatpickr-months .flatpickr-next-month {
+ -webkit-user-select: none;
+ -moz-user-select: none;
+ user-select: none;
text-decoration: none;
cursor: pointer;
position: absolute;
.flatpickr-current-month .flatpickr-monthDropdown-months {
appearance: menulist;
- background: #ff078b;
+ background: #1d7aea;
border: none;
border-radius: 0;
box-sizing: border-box;
}
.flatpickr-current-month .flatpickr-monthDropdown-months .flatpickr-monthDropdown-month {
- background-color: #ff078b;
+ background-color: #1d7aea;
outline: none;
padding: 0;
}
.flatpickr-weekdays {
- background: #ff078b;
+ background: #1d7aea;
text-align: center;
overflow: hidden;
width: 100%;
span.flatpickr-weekday {
cursor: default;
font-size: 90%;
- background: #ff078b;
+ background: #1d7aea;
color: rgba(255,255,255,0.8);
line-height: 1;
margin: 0;
.flatpickr-day.selected.nextMonthDay,
.flatpickr-day.startRange.nextMonthDay,
.flatpickr-day.endRange.nextMonthDay {
- background: #ff078b;
+ background: #1d7aea;
box-shadow: none;
color: #fff;
- border-color: #ff078b;
+ border-color: #1d7aea;
}
.flatpickr-day.selected.startRange,
.flatpickr-day.selected.startRange + .endRange:not(:nth-child(7n+1)),
.flatpickr-day.startRange.startRange + .endRange:not(:nth-child(7n+1)),
.flatpickr-day.endRange.startRange + .endRange:not(:nth-child(7n+1)) {
- box-shadow: -10px 0 0 #ff078b;
+ box-shadow: -10px 0 0 #1d7aea;
}
.flatpickr-day.selected.startRange.endRange,
.flatpickr-day.week.selected {
border-radius: 0;
- box-shadow: -5px 0 0 #ff078b, 5px 0 0 #ff078b;
+ box-shadow: -5px 0 0 #1d7aea, 5px 0 0 #1d7aea;
}
.flatpickr-day.hidden {
-<svg xmlns="http://www.w3.org/2000/svg" xmlns:xlink="http://www.w3.org/1999/xlink" width="362.805" height="97" viewBox="0 0 362.805 97">
+<?xml version="1.0" encoding="UTF-8"?>
+<svg id="Calque_1" data-name="Calque 1" xmlns="http://www.w3.org/2000/svg" version="1.1" xmlns:xlink="http://www.w3.org/1999/xlink" viewBox="0 0 362.8 97">
<defs>
- <clipPath id="clip-path">
- <rect id="Rectangle_235" data-name="Rectangle 235" width="362.805" height="95.676" fill="none"/>
- </clipPath>
- <pattern id="pattern" preserveAspectRatio="none" width="100%" height="100%" viewBox="0 0 240 473">
- <image width="240" height="473" 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"/>
- </pattern>
+ <style>
+ .cls-1 {
+ fill: #001138;
+ }
+
+ .cls-1, .cls-2, .cls-3, .cls-4, .cls-5 {
+ stroke-width: 0px;
+ }
+
+ .cls-2 {
+ fill: url(#Dégradé_sans_nom_3);
+ }
+
+ .cls-3 {
+ fill: url(#Dégradé_sans_nom_2-2);
+ }
+
+ .cls-4 {
+ fill: url(#Dégradé_sans_nom_3-2);
+ }
+
+ .cls-5 {
+ fill: url(#Dégradé_sans_nom_2);
+ }
+ </style>
+ <linearGradient id="Dégradé_sans_nom_3" data-name="Dégradé sans nom 3" x1="933" y1="91.7" x2="991.4" y2="91.7" gradientTransform="translate(0 98) scale(1 -1)" gradientUnits="userSpaceOnUse">
+ <stop offset="0" stop-color="#1d3db8"/>
+ <stop offset="1" stop-color="#1d94ff"/>
+ </linearGradient>
+ <linearGradient id="Dégradé_sans_nom_2" data-name="Dégradé sans nom 2" x1="931.6" y1="143.4" x2="990" y2="143.4" gradientTransform="translate(0 98) scale(1 -1)" gradientUnits="userSpaceOnUse">
+ <stop offset="0" stop-color="#1d94ff"/>
+ <stop offset="1" stop-color="#1d3db8"/>
+ </linearGradient>
+ <linearGradient id="Dégradé_sans_nom_3-2" data-name="Dégradé sans nom 3" x1="1.6" y1="26.6" x2="49.1" y2="26.6" xlink:href="#Dégradé_sans_nom_3"/>
+ <linearGradient id="Dégradé_sans_nom_2-2" data-name="Dégradé sans nom 2" x1=".5" y1="68.6" x2="48" y2="68.6" xlink:href="#Dégradé_sans_nom_2"/>
</defs>
- <g id="Groupe_1465" data-name="Groupe 1465" transform="translate(-78 -62.675)">
- <g id="Groupe_1464" data-name="Groupe 1464" transform="translate(78 62.791)">
- <g id="Groupe_1463" data-name="Groupe 1463">
- <g id="Groupe_1462" data-name="Groupe 1462" clip-path="url(#clip-path)">
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- </g>
- </g>
- </g>
- <rect id="SpinePro_Icon" width="49" height="97" transform="translate(78 62.675)" fill="url(#pattern)"/>
+ <path class="cls-2" d="M964-15.9c-10.1-3-16.6-5.9-21-8.4,4.9,5,10.8,11.7,9,22.9-4.2,25.1-27.7,29.1-15.5,34.9,21.4,10.4,57.9-4.6,54.8-30.9-1.9-8.2-12.4-14.1-27.2-18.5Z"/>
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</g>
-</svg>
+</svg>
\ No newline at end of file
// Inspired by: https://www.sitepoint.com/make-a-simple-javascript-slideshow-without-jquery/
const slides = $scope.find('.header-slideshow-image');
const slidesText = $scope.find('.header-slideshow-content');
- const slideInterval = setInterval(nextSlide, 4000);
+ const slideInterval = setInterval(nextSlide, 10000);
let currentSlide = 0;
initSlideshow();
// Flatpickr calendar control styles
$arrow_hover_color = rgba(#fff, 0.8)
$monthForeground = #fff
-$monthBackground = #FF078B
+$monthBackground = #1D7AEA
$weekdaysBackground = $monthBackground
$weekdaysForeground = rgba($monthForeground, 0.8)
$todayColor = #bbb
-$selectedDayBackground = #FF078B
+$selectedDayBackground = #1D7AEA
$selectedDayForeground = #fff
$noCalendarBorder = true
&.showing
z-index: 10
opacity: 1
+ .header-slideshow-title,
+ .header-slideshow-body
+ opacity: 1
+
&:before
content: none
.elementor-editor-active &, .elementor-editor-preview &
visibility: visible // Animation doesn't trigger in the editor for some reason so just show it
+ &-title,
+ &-body
+ opacity: 0
+ transition: opacity 1s
+
&-title
display: block
font-size: 1.333em // Inherits from parent element so both bits of text can be scaled together
{{-- CONSULTATION FORM --}}
@php /* @var $form \Cube\Forms\Builder\Form */ @endphp
-{{-- SYMPTOMS --}}
-<div class="bg-light text-block-body py-2v pl-4v pr-3v xs:px-2v">
- <h2>{{ __('1. Vos symptômes', 'ccv') }}</h2>
-
- @php $date_placeholder = __('JJ/MM/AAAA', 'ccv'); @endphp
-
- <div class="form-cols-2 mt-1v">
-
- <ul class="spaced-lg">
- <li>{!! $form->field('main-problem') !!}</li>
- <li>
- {!!
- $form->field('date-first-symptoms', [
- 'placeholder' => $date_placeholder,
- 'class' => 'flex items-center spaced-horizontal',
- 'title_class' => 'mb-0',
- 'input_class' => 'date-field-compact',
- 'flatpickr' => [
- 'maxDate' => 'today'
- ]
- ])
- !!}
- </li>
- <li>
- {!!
- $form->field('date-pain-since', [
- 'placeholder' => $date_placeholder,
- 'class' => 'flex items-center spaced-horizontal',
- 'title_class' => 'mb-0',
- 'input_class' => 'date-field-compact',
- 'flatpickr' => [
- 'maxDate' => 'today'
- ]
- ])
- !!}
- </li>
- <li>
- {!! $form->field('pain-arms-legs') !!}
-
- <div class="form-field mt-6 flex xs:flex-wrap">
- {!! $form->title('pain-arms-legs-detail', ['title_class' => 'pr-4']) !!}
- <div class="custom-checkbox -mt-2v pt-2 xs:mt-0 xs:w-full xs:text-center">
- <div class="pain-areas">
- <img src="@asset('images/consultation-body-outline.svg')" class="consultation-body-outline-image">
-
- <span class="absolute text-2xs font-medium" style="top: 5%; right: 70%">{{ __('Droite', 'ccv') }}</span>
- <span class="absolute text-2xs font-medium" style="top: 5%; left: 69%">{{ __('Gauche', 'ccv') }}</span>
-
- @foreach ($form->get_field('pain-arms-legs-detail')->get_options() as $option)
- <label title="{{ $option }}">
- <input type="checkbox" name="pain-arms-legs-detail[]" value="{{ $option }}">
- <span
- class="form-label">{{-- No label here but the element is needed so custom checkboxes work --}}</span>
- </label>
- @endforeach
- </div>
- </div>
- </div>
-
- </li>
- </ul>
-
- <ul class="spaced-lg">
- <li>{!! $form->field('main-pain') !!}</li>
- <li>{!! $form->field('tingling-numbness') !!}</li>
- <li>
- {!!
- $form->field('tingling-numbness-date', [
- 'placeholder' => $date_placeholder,
- 'class' => 'flex items-center spaced-horizontal',
- 'title_class' => 'mb-0',
- 'input_class' => 'date-field-compact',
- 'flatpickr' => [
- 'maxDate' => 'today'
- ]
- ])
- !!}
- </li>
- <li>{!! $form->field('strength-loss') !!}</li>
- <li>
- {!!
- $form->field('strength-loss-date', [
- 'placeholder' => $date_placeholder,
- 'class' => 'flex items-center spaced-horizontal',
- 'title_class' => 'mb-0',
- 'input_class' => 'date-field-compact',
- 'flatpickr' => [
- 'maxDate' => 'today'
- ]
- ])
- !!}
- </li>
- </ul>
-
- </div>
-
-</div>
-
-{{-- TREATMENTS --}}
+{{-- PERSONAL DETAILS --}}
<div class="bg-white py-2v pl-4v pr-3v xs:px-2v">
- <h2>{{ __('2. Vos traitements réalisés', 'ccv') }}</h2>
-
- <div class="spaced-lg mt-1v">
- {!! $form->field('medication', ['title_class' => 'font-light']) !!}
-
- <div class="form-cols-4">
- {!! $form->field('kine-osteo') !!}
- {!! $form->field('corset') !!}
- {!! $form->field('hospitalisation') !!}
- {!! $form->field('infiltration') !!}
- </div>
-
- {!! $form->field('surgeries', ['title_class' => 'font-light']) !!}
- </div>
-
-</div>
-
-{{-- IMAGERY --}}
-<div class="bg-light py-2v pl-4v pr-3v xs:px-2v">
- <h2>{{ __('3. Votre imagerie', 'ccv') }}</h2>
-
- <p class="text-lg my-1v">
- {{ __("IRM, Scanner, Radiographies, faites-nous parvenir vos imageries les plus récentes en utilisant l'une des méthodes suivantes :", 'ccv') }}
- </p>
-
- <div class="form-cols-2">
-
- {{-- IMAGES FROM CD --}}
- <div class="imagery-type-wrapper flex mb-8">
- <input type="radio" id="imagery_cd" name="imagery-type" value="{{ __('Images sur CD (Purview)', 'ccv') }}">
- <label for="imagery_cd" class="imagery-icon">@svg('imagery-cd', 'w-22 md:w-20 sm:w-16')</label>
- <div class="ml-4">
- <div class="text-lg sm:text-base font-normal leading-tight mb-1">
- {{ __('Vos images sont sur un CD ?', 'ccv') }}
- </div>
- <p class="mt-0 sm:text-sm">
- {{ __("Envoyez-nous l'ensemble des fichiers contenus sur votre CD :", "ccv") }}
- </p>
-
- <a href="#purview_uploader" target="_blank" class="btn mt-6" data-lity
- data-update-imagery-type>{{ __('Parcourir', 'ccv') }}</a>
-
- {{-- IMAGE UPLOAD POPUP --}}
- <div id="purview_uploader" class="lity-hide spaced">
-
- <h3 class="text-lg font-body font-normal">
- {{ __('Envoyez vos images au CCV Montpellier en vue d’une téléconsultation', 'ccv') }}
- </h3>
-
- <p>
- {{ __('1. Munissez-vous du CD de votre examen (scanner, IRM, etc) et copiez-le sur votre ordinateur. Un dossier avec le nom du CD va être automatiquement généré.', 'ccv') }}
- </p>
-
- <p>
- {{ __('2. Glissez ce dossier dans la zone ci-dessous. Ou cliquez sur le bouton « Folders and Disks » et sélectionnez le dossier entier correspondant à votre CD.', 'ccv') }}
- <br>
- {{ __('Le téléchargement des images se fait automatiquement.', 'ccv') }}
- </p>
-
- <p>
- {{ __('Les fichiers de scanner et IRM comportent souvent de nombreuses images et le téléchargement peut prendre plusieurs minutes, c’est normal.', 'ccv') }}
- </p>
-
-
- <iframe style="overflow: hidden; margin: 20px auto 0; display: block;" xml="lang" src="https://image-en1.purview.net/dicomuploader.php?auth=eyJ0eXAiOiJKV1QiLCJhbGciOiJIUzI1NiJ9.eyJwcm92aWRlclVJRCI6InBhY3NkYnNjbWdlbmVzdGUiLCJwdWJsaWNVUkxTZWNyZXQiOiJGSzcrdTRIeUMyR3VEOG1LTXNpY0JsNnU0S2RLM0dnRHc3ZlQzcSJ9.iLug1aMBnpHbNAXtLjqGZ_uY3bsQpadBIfqVZhUkZj8" height="620" width="100%" scrolling="no" data-service="uploader.purview"></iframe>
-{{-- <iframe class="block w-full overflow-hidden" height="320"--}}
-{{-- src="https://purview.ccv-montpellier.fr/client/scmgeneste/" scrolling="no"--}}
-{{-- data-service="uploader.purview"></iframe>--}}
-
- <p>
- {{ __('3. Une fois vos images envoyées, la barre de chargement disparait et le descriptif des images apparaît. Le CCV Montpellier aura accès de son côté à vos images.', 'ccv') }}
- </p>
-
- <p>
- {{ __('4. Vous pouvez fermer cette fenêtre et terminer de compléter le formulaire de demande d’avis médical.', 'ccv') }}
- </p>
- </div>
-
- </div>
- </div>
-
- {{-- IMAGES ONLINE --}}
- <div class="imagery-type-wrapper flex mb-8">
- <input type="radio" id="imagery_web" name="imagery-type" value="{{ __('Images en ligne', 'ccv') }}">
- <label for="imagery_web" class="imagery-icon">@svg('imagery-web', 'w-22 md:w-20 sm:w-16')</label>
- <div class="ml-4">
- <div class="text-lg sm:text-base font-normal leading-tight mb-1">
- {{ __('Vous avez reçu un lien pour consulter vos images en ligne ?', 'ccv') }}
- </div>
- <p class="mt-0 mb-0! pb-2 sm:text-sm">
- {{ __('Collez votre lien ci-dessous ainsi que vos identifiant et mot de passe :', 'ccv') }}
- </p>
- <textarea name="imagery-online" class="min-h-0 h-20" data-update-imagery-type></textarea>
- </div>
- </div>
-
- {{-- IMAGES FROM PHONE (NAS UPLOAD) --}}
- <div class="imagery-type-wrapper flex mb-8">
- {!! $form->input('imagery-phone-token') !!}
- {{-- ### NOTE: when this option isn't selected, the 'imagery-phone-token' field will be removed from the form --}}
- {{-- This field is matched based on the value of the translated text below, so make sure to update Consultation::pre_process() too --}}
- <input type="radio" id="imagery_phone" name="imagery-type" value="{{ __('Images téléversées depuis portable', 'ccv') }}">
- <label for="imagery_phone" class="imagery-icon">@svg('imagery-phone', 'w-22 md:w-20 sm:w-16')</label>
- <div class="ml-4">
- <div class="text-lg sm:text-base font-normal leading-tight mb-1">
- {{ __('Vous remplissez cette demande depuis votre téléphone ?', 'ccv') }}
- </div>
- <p class="mt-0 sm:text-sm">
- {{ __('Prenez vos images en photo et envoyez-les directement depuis votre téléphone :', 'ccv') }}
- </p>
-
- {{-- Results from AJAX upload (intially hidden) --}}
- <div id="phone_uploads_result" class="hidden text-sm mt-4">
- <p class="font-normal mb-2">
- {{ __('Images téléchargées :', 'ccv') }}
- </p>
- <ul>
- {{-- Populated by AJAX response --}}
- </ul>
- </div>
+ <h2>{{ __('1. Personal details', 'ccv') }}</h2>
- <a href="#" class="btn mt-6" data-update-imagery-type id="phone-image-browse">{{ __('Parcourir', 'ccv') }}</a>
- </div>
+ <div class="form-cols-2 mt-1v">
+ <div class="spaced-lg">
+ {!! $form->field('name', ['show_title' => false, 'placeholder' => __('Name', 'ccv')]) !!}
+ {!! $form->field('address', ['show_title' => false, 'placeholder' => __('Address', 'ccv')]) !!}
+ {!! $form->field('birthdate', [
+ 'class' => 'flex items-center spaced-horizontal',
+ 'placeholder' => 'DD/MM/YYYY',
+ 'title_class' => 'font-light mb-0',
+ 'flatpickr' => [
+ 'maxDate' => 'today'
+ ]
+ ]) !!}
+ {!! $form->field('email', ['show_title' => false]) !!}
+ {!! $form->field('phone', ['show_title' => false, 'placeholder' => 'Phone number']) !!}
</div>
- {{-- IMAGES SENT BY POST --}}
- <div class="imagery-type-wrapper flex mb-8">
- <input type="radio" id="imagery_post" name="imagery-type" value="{{ __('Images envoyées par courrier', 'ccv') }}">
- <label for="imagery_post" class="imagery-icon">@svg('imagery-post', 'w-22 md:w-20 sm:w-16')</label>
- <div class="ml-4">
- <div class="text-lg sm:text-base font-normal leading-tight mb-1">
- {{ __('Vous pouvez aussi nous envoyer vos images par courrier :', 'ccv') }}
- </div>
- <p class="mt-4 sm:text-sm">
- CCV MONTPELLIER<br>
- AVIS MEDICAL<br>
- Clinique du parc - 50 Rue Emile Combes,<br>
- 34170 Castelnau-le-Lez<br>
- </p>
-
- <div class="custom-checkbox mt-6">
- <label>
- <input type="checkbox" id="images_sent_by_post">
- <span
- class="form-label text-xs">{{ __('Cochez cette case si vous envoyez vos images par courrier', 'ccv') }}</span>
- </label>
- </div>
- </div>
+ <div class="spaced-lg">
+ {!! $form->field('sexe', ['class' => 'flex items-center spaced-horizontal', 'title_class' => 'font-light mb-0']) !!}
+ {!! $form->field('occupation', ['show_title' => false]) !!}
+ {!! $form->field('nationality', ['show_title' => false]) !!}
+ {!! $form->field('contact_preference', ['class' => 'flex items-center spaced-horizontal', 'title_class' => 'font-light mb-0']) !!}
</div>
</div>
- <p class="text-xs italic">
- {{ __("Aucune demande d’avis ne pourra être étudiée sans imagerie médicale associée.", 'ccv') }}
- </p>
-
</div>
-{{-- CONTACT DETAILS --}}
-<div class="bg-white py-2v pl-4v pr-3v xs:px-2v">
- <h2>{{ __('4. Vos informations', 'ccv') }}</h2>
+{{-- TREATMENTS --}}
+<div class="bg-light text-block-body py-2v pl-4v pr-3v xs:px-2v">
+ <h2>{{ __('2. Patient criteria', 'ccv') }}</h2>
<div class="form-cols-2 mt-1v">
-
- <div class="spaced-lg">
- {!! $form->field('last-name', ['show_title' => false]) !!}
- {!! $form->field('first-name', ['show_title' => false]) !!}
- {!! $form->field('profession', ['show_title' => false]) !!}
- {!! $form->field('postcode', ['show_title' => false]) !!}
- {!! $form->field('city', ['show_title' => false]) !!}
- {!! $form->field('country', ['show_title' => false]) !!}
- {!! $form->field('phone', ['show_title' => false]) !!}
- {!! $form->field('email', ['show_title' => false]) !!}
- </div>
-
- <div class="spaced-lg">
- {!! $form->field('sex', ['class' => 'flex items-center spaced-horizontal', 'title_class' => 'font-light mb-0']) !!}
- {!! $form->field('age', [
- 'class' => 'flex items-center spaced-horizontal',
- 'title_class' => 'font-light mb-0',
- 'input_class' => 'flex items-center w-16',
- 'placeholder' => '',
- 'field_after' => __('ans', 'ccv')
- ]) !!}
- {!! $form->field('message', ['class' => 'mt-6', 'title_class' => 'font-light']) !!}
-
- <div class="mt-4">
- <div class="custom-checkbox mb-1">
- <label>
- <input type="checkbox" name="send-to-team" value="{{ __('Oui', 'ccv') }}" checked class="ml-2">
- <span class="form-label-reversed">{{ __("J'envoie ma demande à l'équipe du CCV", 'ccv') }}</span>
- </label>
+ <ul class="spaced-lg">
+ <li>{!! $form->field('lumbar-dic-disease') !!}</li>
+ <li>{!! $form->field('chronic-pain') !!}</li>
+ <li>{!! $form->field('suffering-time') !!}</li>
+ <li>
+ <div class="form-field">
+ <div class="form-field-title">{{ 'How long have you been suffering?' }}</div>
+ <div class="flex spaced-horizontal gap-12">
+ {!! $form->field('years', [
+ 'class' => 'flex items-center spaced-horizontal',
+ 'title_class' => 'font-light mb-0',
+ 'input_class' => 'flex items-center w-24',
+ 'placeholder' => '',
+ 'field_after' => __('Years', 'ccv'),
+ 'show_title' => false,
+ ]) !!}
+ {!! $form->field('months', [
+ 'class' => 'flex items-center spaced-horizontal',
+ 'title_class' => 'font-light mb-0',
+ 'input_class' => 'flex items-center w-24',
+ 'placeholder' => '',
+ 'field_after' => __('Months', 'ccv'),
+ 'show_title' => false,
+ ]) !!}
+ </div>
</div>
- {{ __("ou je souhaite l'envoyer à un chirurgien spécifique :", 'ccv') }}
-
- @php
- // The options for this field contains the e-mail address as the value but we don't want to expose that here
- // so we override options with a new array made up of just their names as both the key and value.
- // Once the form is processed, this will be used to look up the e-mail address.
- $surgeons = array_keys($form->get_field('surgeon')->get_options());
- $surgeons_options = array_combine($surgeons, $surgeons);
- @endphp
- {!! $form->field('surgeon', [
- 'class' => 'mt-4',
- 'show_title' => false,
- 'options' => $surgeons_options,
- 'placeholder' => [
- '' => __('Sélectionner', 'ccv') // First select option
- ]
- ]) !!}
- </div>
- </div>
-
+ </li>
+ <li>{!! $form->field('lumbar-mri-scan') !!}</li>
+ </ul>
+ <ul class="spaced-lg">
+ <li>{!! $form->field('cortisone-injection') !!}</li>
+ <li>{!! $form->field('ready-for-surgery') !!}</li>
+ <li>{!! $form->field('willing-to-travel') !!}</li>
+ <li>{!! $form->field('able-to-self-fund') !!}</li>
+ </ul>
</div>
-
{!!
- $form->button(__('Envoyer votre demande', 'ccv'), [
- 'class' => 'btn block mt-1v ml-auto',
+ $form->button(__('Submit', 'ccv'), [
+ 'class' => 'btn block mt-2v mx-auto',
'loading_text' => __('Envoi en cours...', 'ccv'),
])
!!}
-
</div>
-@push('afterform')
- <form action="https://ccvmontpellier34.synology.me/upload.php" id="phone-file-upload-form" method="post"
- enctype="multipart/form-data" style="visibility:hidden;height:1px;position:absolute;top:0;">
- <input type="file" multiple="multiple" name="files[]" id="phone-file-upload-field" accept="image/*" capture/>
- </form>
- <script>
- (function ($) {
- // Clicking browse triggers the file form. It opens the dialog to capture images or browse files
- $('#phone-image-browse').on('click touchend', function () {
- $('#phone-file-upload-field').click();
- });
- // If the field has been updated (e.g not canceled), submit the form
- $('#phone-file-upload-field').on('change', function () {
- var form_data = new FormData();
- var fileInput = document.getElementById('phone-file-upload-field');
-
- // Read selected files
- var totalfiles = fileInput.files.length;
- for (var index = 0; index < totalfiles; index++) {
- form_data.append('files[]', fileInput.files[index]);
- }
- form_data.append('token', '{{ $form->get_field('imagery-phone-token')->get_value() }}');
-
- var form = $('#phone-file-upload-form');
- var button = $('#phone-image-browse');
-
- button.text("{{ __("Chargement des fichiers", 'ccv') }}");
-
- // AJAX request
- $.ajax({
- url: form.attr('action'),
- type: form.attr('method'),
- data: form_data,
- dataType: 'json',
- contentType: false,
- processData: false,
- success: function (response) {
-
- if (parseInt(response.successful_uploads) > 0) {
-
- var $result = $('#phone_uploads_result');
-
- for (var i = 0; i < response.uploads.length; i++) {
- $result.find('ul').append('<li>— ' + response.uploads[i] + '</li>');
- }
-
- $result.show();
- }
-
- setTimeout(function () {
- button.text("{{ __("Parcourir", 'ccv') }}");
- }, 2000);
- button.text("{{ __("Chargement terminé", 'ccv') }}");
- }
- });
-
- return true;
- });
- })(jQuery);
- </script>
-@endpush
-
{{-- Custom classes for form message container --}}
@push('message_class')
py-2v pl-4v pr-3v xs:px-2v
projects / spinepro.git / commitdiff
