From 3d17751269402eb57312341605e7e21796a32630 Mon Sep 17 00:00:00 2001 From: soufiane Date: Thu, 10 Oct 2024 12:18:44 +0200 Subject: [PATCH] wait #6967 @9:00 --- wp-content/mu-plugins/cube/src/Forms/Base.php | 12 +- .../cube/src/Forms/Consultation.php | 126 +++--- wp-content/themes/CCV/dist/styles/app.css | 11 + .../themes/CCV/dist/styles/flatpickr.css | 41 +- .../CCV/resources/assets/images/logo.svg | 75 ++- .../assets/scripts/header-slideshow.js | 2 +- .../resources/assets/styles/flatpickr.styl | 4 +- .../styles/widgets/header-slideshow.styl | 9 + .../views/forms/consultation.blade.php | 426 +++--------------- 9 files changed, 223 insertions(+), 483 deletions(-) diff --git a/wp-content/mu-plugins/cube/src/Forms/Base.php b/wp-content/mu-plugins/cube/src/Forms/Base.php index 63fdf946..3952fda5 100644 --- a/wp-content/mu-plugins/cube/src/Forms/Base.php +++ b/wp-content/mu-plugins/cube/src/Forms/Base.php @@ -231,13 +231,13 @@ class Base public function process() { - $this->pre_process(); + //$this->pre_process(); $headers = []; $data = []; $to = $this->destination; - $from = 'CCV Montpellier '; + $from = 'Spine pro '; $subject = $this->form_title; $content_type = 'text/html'; $charset = get_bloginfo('charset'); @@ -246,11 +246,15 @@ class Base // Gather filled fields into label/value pairs foreach ($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 diff --git a/wp-content/mu-plugins/cube/src/Forms/Consultation.php b/wp-content/mu-plugins/cube/src/Forms/Consultation.php index 7bc7973c..c31c91d0 100644 --- a/wp-content/mu-plugins/cube/src/Forms/Consultation.php +++ b/wp-content/mu-plugins/cube/src/Forms/Consultation.php @@ -35,94 +35,78 @@ class Consultation extends Base { $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); @@ -147,5 +131,5 @@ class Consultation extends Base { $this->set_destination($surgeons[$this->get_data('surgeon')]); } } - } + }*/ } diff --git a/wp-content/themes/CCV/dist/styles/app.css b/wp-content/themes/CCV/dist/styles/app.css index 63d2f531..447d6409 100644 --- a/wp-content/themes/CCV/dist/styles/app.css +++ b/wp-content/themes/CCV/dist/styles/app.css @@ -2930,6 +2930,11 @@ h4, 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; } @@ -2968,6 +2973,12 @@ h4, visibility: visible; } +.header-slideshow-title, +.header-slideshow-body { + opacity: 0; + transition: opacity 1s; +} + .header-slideshow-title { display: block; font-size: 1.333em; diff --git a/wp-content/themes/CCV/dist/styles/flatpickr.css b/wp-content/themes/CCV/dist/styles/flatpickr.css index 834dd676..7d064d30 100644 --- a/wp-content/themes/CCV/dist/styles/flatpickr.css +++ b/wp-content/themes/CCV/dist/styles/flatpickr.css @@ -71,16 +71,16 @@ 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; } @@ -101,11 +101,19 @@ } .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; @@ -126,7 +134,7 @@ } .flatpickr-calendar.arrowTop:after { - border-bottom-color: #ff078b; + border-bottom-color: #1d7aea; } .flatpickr-calendar.arrowBottom:before, @@ -139,7 +147,7 @@ } .flatpickr-calendar.arrowBottom:after { - border-top-color: #ff078b; + border-top-color: #1d7aea; } .flatpickr-calendar:focus { @@ -157,7 +165,7 @@ .flatpickr-months .flatpickr-month { border-radius: 5px 5px 0 0; - background: #ff078b; + background: #1d7aea; color: #fff; fill: #fff; height: 34px; @@ -173,6 +181,9 @@ .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; @@ -423,7 +434,7 @@ .flatpickr-current-month .flatpickr-monthDropdown-months { appearance: menulist; - background: #ff078b; + background: #1d7aea; border: none; border-radius: 0; box-sizing: border-box; @@ -455,13 +466,13 @@ } .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%; @@ -478,7 +489,7 @@ span.flatpickr-weekday { cursor: default; font-size: 90%; - background: #ff078b; + background: #1d7aea; color: rgba(255,255,255,0.8); line-height: 1; margin: 0; @@ -595,10 +606,10 @@ span.flatpickr-weekday { .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, @@ -616,7 +627,7 @@ span.flatpickr-weekday { .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, @@ -651,7 +662,7 @@ span.flatpickr-weekday { .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 { diff --git a/wp-content/themes/CCV/resources/assets/images/logo.svg b/wp-content/themes/CCV/resources/assets/images/logo.svg index 515925b5..dd807d42 100644 --- a/wp-content/themes/CCV/resources/assets/images/logo.svg +++ b/wp-content/themes/CCV/resources/assets/images/logo.svg @@ -1,27 +1,54 @@ - + + - - - - - - + + + + + + + + + + + - - - - - - - - - - - - - - - - + + + + + + + + + + + + + - + \ No newline at end of file diff --git a/wp-content/themes/CCV/resources/assets/scripts/header-slideshow.js b/wp-content/themes/CCV/resources/assets/scripts/header-slideshow.js index f1f15bbf..ccb9642d 100644 --- a/wp-content/themes/CCV/resources/assets/scripts/header-slideshow.js +++ b/wp-content/themes/CCV/resources/assets/scripts/header-slideshow.js @@ -8,7 +8,7 @@ import debounce from 'lodash.debounce'; // 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(); diff --git a/wp-content/themes/CCV/resources/assets/styles/flatpickr.styl b/wp-content/themes/CCV/resources/assets/styles/flatpickr.styl index 27da9ea3..da06ca23 100644 --- a/wp-content/themes/CCV/resources/assets/styles/flatpickr.styl +++ b/wp-content/themes/CCV/resources/assets/styles/flatpickr.styl @@ -1,7 +1,7 @@ // Flatpickr calendar control styles $arrow_hover_color = rgba(#fff, 0.8) $monthForeground = #fff -$monthBackground = #FF078B +$monthBackground = #1D7AEA $weekdaysBackground = $monthBackground $weekdaysForeground = rgba($monthForeground, 0.8) @@ -10,7 +10,7 @@ $dayHoverBackground = #e2e2e2 $todayColor = #bbb -$selectedDayBackground = #FF078B +$selectedDayBackground = #1D7AEA $selectedDayForeground = #fff $noCalendarBorder = true diff --git a/wp-content/themes/CCV/resources/assets/styles/widgets/header-slideshow.styl b/wp-content/themes/CCV/resources/assets/styles/widgets/header-slideshow.styl index 461464d9..a897aea3 100644 --- a/wp-content/themes/CCV/resources/assets/styles/widgets/header-slideshow.styl +++ b/wp-content/themes/CCV/resources/assets/styles/widgets/header-slideshow.styl @@ -99,6 +99,10 @@ $title_bg = rgba(#031236, 0.84) &.showing z-index: 10 opacity: 1 + .header-slideshow-title, + .header-slideshow-body + opacity: 1 + &:before content: none @@ -122,6 +126,11 @@ $title_bg = rgba(#031236, 0.84) .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 diff --git a/wp-content/themes/CCV/resources/views/forms/consultation.blade.php b/wp-content/themes/CCV/resources/views/forms/consultation.blade.php index 12a8cb82..01e369f8 100644 --- a/wp-content/themes/CCV/resources/views/forms/consultation.blade.php +++ b/wp-content/themes/CCV/resources/views/forms/consultation.blade.php @@ -1,392 +1,86 @@ {{-- CONSULTATION FORM --}} @php /* @var $form \Cube\Forms\Builder\Form */ @endphp -{{-- SYMPTOMS --}} -
-

{{ __('1. Vos symptômes', 'ccv') }}

- - @php $date_placeholder = __('JJ/MM/AAAA', 'ccv'); @endphp - -
- -
    -
  • {!! $form->field('main-problem') !!}
    • -
  • - {!! - $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' - ] - ]) - !!} -
    • -
  • - {!! - $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' - ] - ]) - !!} -
    • -
  • - {!! $form->field('pain-arms-legs') !!} - -
    - {!! $form->title('pain-arms-legs-detail', ['title_class' => 'pr-4']) !!} -
    -
    - - - {{ __('Droite', 'ccv') }} - {{ __('Gauche', 'ccv') }} - - @foreach ($form->get_field('pain-arms-legs-detail')->get_options() as $option) - - @endforeach -
    -
    -
    - -
    • -
- -
    -
  • {!! $form->field('main-pain') !!}
    • -
  • {!! $form->field('tingling-numbness') !!}
    • -
  • - {!! - $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' - ] - ]) - !!} -
    • -
  • {!! $form->field('strength-loss') !!}
    • -
  • - {!! - $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' - ] - ]) - !!} -
    • -
- -
- -
- -{{-- TREATMENTS --}} +{{-- PERSONAL DETAILS --}}
-

{{ __('2. Vos traitements réalisés', 'ccv') }}

- -
- {!! $form->field('medication', ['title_class' => 'font-light']) !!} - -
- {!! $form->field('kine-osteo') !!} - {!! $form->field('corset') !!} - {!! $form->field('hospitalisation') !!} - {!! $form->field('infiltration') !!} -
- - {!! $form->field('surgeries', ['title_class' => 'font-light']) !!} -
- -
- -{{-- IMAGERY --}} -
-

{{ __('3. Votre imagerie', 'ccv') }}

- -

- {{ __("IRM, Scanner, Radiographies, faites-nous parvenir vos imageries les plus récentes en utilisant l'une des méthodes suivantes :", 'ccv') }} -

- -
- - {{-- IMAGES FROM CD --}} -
- - -
-
- {{ __('Vos images sont sur un CD ?', 'ccv') }} -
-

- {{ __("Envoyez-nous l'ensemble des fichiers contenus sur votre CD :", "ccv") }} -

- - {{ __('Parcourir', 'ccv') }} - - {{-- IMAGE UPLOAD POPUP --}} -
- -

- {{ __('Envoyez vos images au CCV Montpellier en vue d’une téléconsultation', 'ccv') }} -

- -

- {{ __('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') }} -

- -

- {{ __('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') }} -
- {{ __('Le téléchargement des images se fait automatiquement.', 'ccv') }} -

- -

- {{ __('Les fichiers de scanner et IRM comportent souvent de nombreuses images et le téléchargement peut prendre plusieurs minutes, c’est normal.', 'ccv') }} -

- - - -{{-- --}} - -

- {{ __('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') }} -

- -

- {{ __('4. Vous pouvez fermer cette fenêtre et terminer de compléter le formulaire de demande d’avis médical.', 'ccv') }} -

-
- -
-
- - {{-- IMAGES ONLINE --}} -
- - -
-
- {{ __('Vous avez reçu un lien pour consulter vos images en ligne ?', 'ccv') }} -
-

- {{ __('Collez votre lien ci-dessous ainsi que vos identifiant et mot de passe :', 'ccv') }} -

- -
-
- - {{-- IMAGES FROM PHONE (NAS UPLOAD) --}} -
- {!! $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 --}} - - -
-
- {{ __('Vous remplissez cette demande depuis votre téléphone ?', 'ccv') }} -
-

- {{ __('Prenez vos images en photo et envoyez-les directement depuis votre téléphone :', 'ccv') }} -

- - {{-- Results from AJAX upload (intially hidden) --}} - +

{{ __('1. Personal details', 'ccv') }}

- {{ __('Parcourir', 'ccv') }} -
+
+
+ {!! $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']) !!}
- {{-- IMAGES SENT BY POST --}} -
- - -
-
- {{ __('Vous pouvez aussi nous envoyer vos images par courrier :', 'ccv') }} -
-

- CCV MONTPELLIER
- AVIS MEDICAL
- Clinique du parc - 50 Rue Emile Combes,
- 34170 Castelnau-le-Lez
-

- -
- -
-
+
+ {!! $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']) !!}
-

- {{ __("Aucune demande d’avis ne pourra être étudiée sans imagerie médicale associée.", 'ccv') }} -

-
-{{-- CONTACT DETAILS --}} -
-

{{ __('4. Vos informations', 'ccv') }}

+{{-- TREATMENTS --}} +
+

{{ __('2. Patient criteria', 'ccv') }}

- -
- {!! $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]) !!} -
- -
- {!! $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']) !!} - -
-
- +
    +
  • {!! $form->field('lumbar-dic-disease') !!}
    • +
  • {!! $form->field('chronic-pain') !!}
    • +
  • {!! $form->field('suffering-time') !!}
    • +
  • +
    +
    {{ 'How long have you been suffering?' }}
    +
    + {!! $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, + ]) !!} +
    - {{ __("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 - ] - ]) !!} -
-
- + +
  • {!! $form->field('lumbar-mri-scan') !!}
    • + +
      +
    • {!! $form->field('cortisone-injection') !!}
      • +
    • {!! $form->field('ready-for-surgery') !!}
      • +
    • {!! $form->field('willing-to-travel') !!}
      • +
    • {!! $form->field('able-to-self-fund') !!}
      • +
    - {!! - $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'), ]) !!} -
    -@push('afterform') - - -@endpush - {{-- Custom classes for form message container --}} @push('message_class') py-2v pl-4v pr-3v xs:px-2v -- 2.39.5