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@@ -63,19 +63,19 @@
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@endif
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</div>
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<div class="col-lg-6 form-group mb-4">
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- <input type="text" class="form-control rounded-0 py-3" name="name_first" placeholder="First Name" value="{{ old('name_first') }}" />
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+ <input type="text" class="form-control rounded-0 py-3" name="name_first" placeholder="First Name" value="{{ old('name_first') }}" required />
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@error('name_first')
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<small class="text-warning">{{$message}}</small>
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@enderror
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</div>
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<div class="col-lg-6 form-group mb-4">
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- <input type="text" class="form-control rounded-0 py-3" name="name_last" placeholder="Last Name" value="{{ old('name_last') }}" />
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+ <input type="text" class="form-control rounded-0 py-3" name="name_last" placeholder="Last Name" value="{{ old('name_last') }}" required />
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@error('name_last')
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<small class="text-warning">{{$message}}</small>
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@enderror
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</div>
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<div class="col-lg-12 form-group mb-4">
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- <input type="text" class="form-control rounded-0 py-3" name="practice_name" placeholder="Practice Name" value="{{ old('practice_name') }}" />
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+ <input type="text" class="form-control rounded-0 py-3" name="practice_name" placeholder="Practice Name" value="{{ old('practice_name') }}" required />
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@error('practice_name')
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<small class="text-warning">{{$message}}</small>
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@enderror
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@@ -83,13 +83,13 @@
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</div>
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<div class="row">
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<div class="col-lg-6 form-group mb-4">
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- <input type="email" class="form-control rounded-0 py-3" name="email" placeholder="Contact Email" value="{{ old('email') }}" />
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+ <input type="email" class="form-control rounded-0 py-3" name="email" placeholder="Contact Email" value="{{ old('email') }}" required />
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@error('email')
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<small class="text-warning">{{$message}}</small>
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@enderror
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</div>
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<div class="col-lg-6 form-group mb-4">
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- <input type="text" class="form-control rounded-0 py-3" name="phone" placeholder="Contact Phone Number" value="{{ old('phone') }}" />
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+ <input type="text" class="form-control rounded-0 py-3" name="phone" placeholder="Contact Phone Number" value="{{ old('phone') }}" required />
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@error('phone')
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<small class="text-warning">{{$message}}</small>
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@enderror
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@@ -97,25 +97,31 @@
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</div>
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<div class="form-group mb-4">
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- <input type="text" class="form-control rounded-0 py-3" name="zip" placeholder="Zip Code" value="{{ old('zip') }}" />
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+ <input type="text" class="form-control rounded-0 py-3" name="zip" placeholder="Zip Code" value="{{ old('zip') }}" required />
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@error('zip')
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<small class="text-warning">{{$message}}</small>
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@enderror
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</div>
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<div class="row">
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<div class="col-lg-6 form-group mb-4">
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- <select class="form-control rounded-0 py-3" name="training_type">
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+ <select class="form-control rounded-0 py-3" name="training_type" onchange="return showField(this, 'other')">
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<option value="">Training Type</option>
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- <option value="Clinical Training">Clinical Training</option>
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- <option value="Staff Training">Staff Training</option>
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- <option value="Other">Other</option>
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+ <option value="clinical">Clinical Training</option>
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+ <option value="staff">Staff Training</option>
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+ <option value="other">Other</option>
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</select>
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@error('training_type')
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<small class="text-warning">{{$message}}</small>
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@enderror
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</div>
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+ <div class="col-lg-6 form-group mb-4 training_type d-none">
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+ <input type="text" class="form-control rounded-0 py-3" placeholder="Other training type" name="training_type_other" value="{{ old('training_type_other') }}">
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+ @error('training_type_other')
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+ <small class="text-warning">{{$message}}</small>
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+ @enderror
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+ </div>
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<div class="col-lg-6 form-group mb-4">
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- <select class="form-control rounded-0 py-3" name="training_format">
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+ <select class="form-control rounded-0 py-3" name="training_format" required>
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<option value="">Training Format</option>
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<option value="In-person">In-person</option>
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<option value="Online">Online</option>
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@@ -137,4 +143,18 @@
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</div>
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</div>
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</div>
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+
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+<script type="text/javascript">
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+ function showField(_elem, _trigger) {
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+ var name = _elem.name;
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+ var val = $(_elem).val();
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+ if (val == _trigger) {
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+ $('.'+name).removeClass('d-none')
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+ }else {
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+ $('.'+name).addClass('d-none');
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+ }
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+ }
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+</script>
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+
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+
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@endsection
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