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@@ -36,243 +36,249 @@
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</div>
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</div>
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</div>
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-<div class="container py-5">
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- <div class="row justify-content-center">
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- @if(session('success'))
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- <div class="col-12">
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- <div class="alert alert-success" role="alert">
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- <h4 class="alert-heading">Congratulations!!</h4>
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- <p>You have successfully completed this survey. Eligible submissions will receive a digital gift cards in 7 business days to the email provided in the survey. </p>
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- <hr>
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- <p class="mb-0">Questions? please feel free to write us at <a href="mailto:info@hemband.com">info@hemband.com</a> or call us at <a href="tel:(800) 242-6145">(800) 242-6145</a></p>
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- </div>
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- </div>
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- @else
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- <div id="surveyQuestionsComponent" class="col-md-12">
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- <form action="{{ route('submit-survey-questions') }}" method="POST">
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- @csrf
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- <div class="row mb-3">
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- <div class="col-12">
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- <div class="bg-light border p-3">
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- <div class="row">
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- <div class="col-md-4">
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- <div class="form-group">
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- <label>Name<sup class="text-danger">*</sup></label>
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- <input type="text" class="form-control" name="name" value="{{ old('name') }}" required />
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- </div>
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- </div>
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- <div class="col-md-4">
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- <div class="form-group">
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- <label>Email<sup class="text-danger">*</sup></label>
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- <input type="email" class="form-control" name="email" value="{{ old('email') }}" required />
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- <small class="text-muted">(to receive digital gift card)</small>
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- </div>
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- </div>
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- <div class="col-md-4">
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- <div class="form-group">
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- <label>Cell Number</label>
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- <input type="text" class="form-control" name="cell_number" value="{{ old('cell_number') }}" />
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- </div>
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- </div>
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- </div>
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- <div class="row">
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- <div class="col-md-6">
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- <div class="form-group">
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- <label>Practice Address Line 1</label>
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- <input type="text" class="form-control" name="practice_address_line_1" value="{{ old('practice_address_line_1') }}" />
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- </div>
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- </div>
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- <div class="col-md-6">
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- <div class="form-group">
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- <label>Practice Address Line 2</label>
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- <input type="text" class="form-control" name="practice_address_line_2" value="{{ old('practice_address_line_2') }}" />
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- </div>
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- </div>
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- <div class="col-md-6">
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- <div class="form-group">
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- <label>Practice Address City</label>
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- <input type="text" class="form-control" name="practice_address_city" value="{{ old('practice_address_city') }}" />
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- </div>
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- </div>
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- <div class="col-md-6">
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- <div class="form-group">
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- <label>Practice Address State</label>
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- <select class="form-control" name="practice_address_state">
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- <option value=""></option>
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- @foreach(config('constants.us_states') as $stateKey => $stateLabel)
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- <option value="{{ $stateKey }}" <?= old('practice_address_state') === $stateKey ? 'selected':'' ?>>{{ $stateLabel }}</option>
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- @endforeach
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- </select>
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- </div>
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- </div>
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- </div>
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- </div>
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- </div>
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- </div>
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- <div class="row mb-3">
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- <div class="col-12 question">
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- <div class="form-group">
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- <label>Are you a gastroenterologist?</label>
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- <div class="d-flex flex-column">
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- <label><input type="radio" name="are_you_a_gastroenterologist" v-model="form.are_you_a_gastroenterologist" value="YES" /> <span>Yes</span></label>
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- <label><input type="radio" name="are_you_a_gastroenterologist" v-model="form.are_you_a_gastroenterologist" value="NO" /> <span>No</span></label>
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- </div>
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- </div>
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- <div v-if="form.are_you_a_gastroenterologist == 'NO'" class="form-group">
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- <label>Your speciality?<sup class="text-danger">*</sup></label>
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- <input type="text" class="form-control" name="your_specialty" value="{{ old('your_specialty') }}" required />
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- </div>
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+<div class="container py-4">
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+ <div class="row justify-content-center">
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+ <div class="col-lg-8">
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+ <div class="container shadow p-4">
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+ <div class="row justify-content-center">
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+ @if(session('success'))
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+ <div class="col-12">
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+ <div class="alert alert-success" role="alert">
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+ <h4 class="alert-heading">Congratulations!!</h4>
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+ <p>You have successfully completed this survey. Eligible submissions will receive a digital gift cards in 7 business days to the email provided in the survey. </p>
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+ <hr>
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+ <p class="mb-0">Questions? please feel free to write us at <a href="mailto:info@hemband.com">info@hemband.com</a> or call us at <a href="tel:(800) 242-6145">(800) 242-6145</a></p>
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+ </div>
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+ </div>
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+ @else
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+ <div id="surveyQuestionsComponent" class="col-md-12">
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+ <form action="{{ route('submit-survey-questions') }}" method="POST">
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+ @csrf
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+ <div class="row mb-3">
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+ <div class="col-12">
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+ <div class="">
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+ <div class="row">
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+ <div class="col-md-12 mb-3">
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+ <div class="form-group">
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+ <label>Name<sup class="text-danger">*</sup></label>
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+ <input type="text" class="form-control" name="name" value="{{ old('name') }}" required />
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+ </div>
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+ </div>
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+ <div class="col-md-6 mb-3">
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+ <div class="form-group">
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+ <label>Email<sup class="text-danger">*</sup></label>
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+ <input type="email" class="form-control" name="email" value="{{ old('email') }}" required />
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+ <small class="text-muted">(to receive digital gift card)</small>
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+ </div>
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+ </div>
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+ <div class="col-md-6 mb-3">
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+ <div class="form-group">
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+ <label>Cell Number</label>
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+ <input type="text" class="form-control" name="cell_number" value="{{ old('cell_number') }}" />
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+ </div>
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+ </div>
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+ </div>
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+ <div class="row">
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+ <div class="col-md-6 mb-3">
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+ <div class="form-group ">
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+ <label>Practice Address Line 1</label>
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+ <input type="text" class="form-control" name="practice_address_line_1" value="{{ old('practice_address_line_1') }}" />
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+ </div>
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+ </div>
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+ <div class="col-md-6 mb-3">
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+ <div class="form-group ">
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+ <label>Practice Address Line 2</label>
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+ <input type="text" class="form-control" name="practice_address_line_2" value="{{ old('practice_address_line_2') }}" />
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+ </div>
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+ </div>
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+ <div class="col-md-6 mb-3">
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+ <div class="form-group ">
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+ <label>Practice Address City</label>
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+ <input type="text" class="form-control" name="practice_address_city" value="{{ old('practice_address_city') }}" />
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+ </div>
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+ </div>
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+ <div class="col-md-6 mb-3">
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+ <div class="form-group">
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+ <label>Practice Address State</label>
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+ <select class="form-control" name="practice_address_state">
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+ <option value=""></option>
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+ @foreach(config('constants.us_states') as $stateKey => $stateLabel)
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+ <option value="{{ $stateKey }}" <?= old('practice_address_state') === $stateKey ? 'selected':'' ?>>{{ $stateLabel }}</option>
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+ @endforeach
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+ </select>
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+ </div>
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+ </div>
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+ </div>
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+ </div>
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+ </div>
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+ </div>
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+ <div class="row mb-3">
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+ <div class="col-12 question">
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+ <div class="form-group">
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+ <label>Are you a gastroenterologist?</label>
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+ <div class="d-flex">
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+ <label class="me-3"><input type="radio" name="are_you_a_gastroenterologist" v-model="form.are_you_a_gastroenterologist" value="YES" /> <span>Yes</span></label>
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+ <label><input type="radio" name="are_you_a_gastroenterologist" v-model="form.are_you_a_gastroenterologist" value="NO" /> <span>No</span></label>
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+ </div>
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+ </div>
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+ <div v-if="form.are_you_a_gastroenterologist == 'NO'" class="form-group">
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+ <label>Your speciality?<sup class="text-danger">*</sup></label>
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+ <input type="text" class="form-control" name="your_specialty" value="{{ old('your_specialty') }}" required />
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+ </div>
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- </div>
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- </div>
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- <div class="row mb-3">
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- <div class="col-12 question">
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- <div class="form-group">
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- <label>Years in practice</label>
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- <div id="rangeSlider" class="noUiSlider"></div>
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- <input type="hidden" name="years_in_practice" :value="form.years_in_practice" />
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- </div>
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+ </div>
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+ </div>
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+ <div class="row mb-3">
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+ <div class="col-12 question">
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+ <div class="form-group">
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+ <label>Years in practice</label>
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+ <div id="rangeSlider" class="noUiSlider"></div>
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+ <input type="hidden" name="years_in_practice" :value="form.years_in_practice" />
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+ </div>
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- </div>
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- </div>
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- <div class="row mb-3">
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- <div class="col-12 question">
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- <div class="form-group">
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- <label>Where do you perform your regular procedures?</label>
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- <div class="d-flex flex-column">
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- <label><input type="checkbox" name="where_do_you_perform_regular_procedures[]" value="Office"> <span>Office</span></label>
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- <label><input type="checkbox" name="where_do_you_perform_regular_procedures[]" value="Endoscopy Center"> <span>Endoscopy Center</span></label>
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- <label><input type="checkbox" name="where_do_you_perform_regular_procedures[]" value="ASC"> <span>ASC</span></label>
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- <label><input type="checkbox" name="where_do_you_perform_regular_procedures[]" value="Hospital"> <span>Hospital</span></label>
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- </div>
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- </div>
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+ </div>
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+ </div>
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+ <div class="row mb-3">
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+ <div class="col-12 question">
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+ <div class="form-group">
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+ <label>Where do you perform your regular procedures?</label>
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+ <div class="d-flex flex-column">
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+ <label><input type="checkbox" name="where_do_you_perform_regular_procedures[]" value="Office"> <span>Office</span></label>
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+ <label><input type="checkbox" name="where_do_you_perform_regular_procedures[]" value="Endoscopy Center"> <span>Endoscopy Center</span></label>
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+ <label><input type="checkbox" name="where_do_you_perform_regular_procedures[]" value="ASC"> <span>ASC</span></label>
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+ <label><input type="checkbox" name="where_do_you_perform_regular_procedures[]" value="Hospital"> <span>Hospital</span></label>
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+ </div>
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+ </div>
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- </div>
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- </div>
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- <div class="row mb-3">
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- <div class="col-12 question">
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- <div class="form-group">
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- <label>Do you perform any procedures for the Hemorrhoids?</label>
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- <div class="d-flex flex-column">
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- <label><input type="radio" name="do_you_perform_any_procedures_for_the_hemorrhoids" v-model="form.do_you_perform_any_procedures_for_the_hemorrhoids" value="YES" /> <span>Yes</span></label>
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- <label><input type="radio" name="do_you_perform_any_procedures_for_the_hemorrhoids" v-model="form.do_you_perform_any_procedures_for_the_hemorrhoids" value="NO" /> <span>No, I refere to the speciality centers</span></label>
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- </div>
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- </div>
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- <div v-if="form.do_you_perform_any_procedures_for_the_hemorrhoids == 'YES'" class="form-group">
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- <label>If yes, what types of the procedures you preform?<sup class="text-danger">*</sup></label>
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- <div class="d-flex flex-column">
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- <label><input type="checkbox" name="what_types_of_the_procedures_you_preform[]" value="Hemorrhoid Banding" /> <span>Hemorrhoid Banding</span></label>
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- <label><input type="checkbox" name="what_types_of_the_procedures_you_preform[]" value="Infrared Coagulation" /> <span>Infrared Coagulation</span></label>
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- <label><input type="checkbox" name="what_types_of_the_procedures_you_preform[]" value="Sclerotherapy" /> <span>Sclerotherapy</span></label>
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- <label><input type="checkbox" name="what_types_of_the_procedures_you_preform[]" value="Hemorrhoid stapling" /> <span>Hemorrhoid stapling</span></label>
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- <label><input type="checkbox" name="what_types_of_the_procedures_you_preform[]" value="Hemorrhoidectomy" /> <span>Hemorrhoidectomy</span></label>
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- </div>
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- </div>
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+ </div>
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+ </div>
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+ <div class="row mb-3">
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+ <div class="col-12 question">
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+ <div class="form-group">
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+ <label>Do you perform any procedures for the Hemorrhoids?</label>
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+ <div class="d-flex">
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+ <label class="me-3"><input type="radio" name="do_you_perform_any_procedures_for_the_hemorrhoids" v-model="form.do_you_perform_any_procedures_for_the_hemorrhoids" value="YES" /> <span>Yes</span></label>
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+ <label><input type="radio" name="do_you_perform_any_procedures_for_the_hemorrhoids" v-model="form.do_you_perform_any_procedures_for_the_hemorrhoids" value="NO" /> <span>No, I refer to the speciality centers</span></label>
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+ </div>
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+ </div>
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+ <div v-if="form.do_you_perform_any_procedures_for_the_hemorrhoids == 'YES'" class="form-group">
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+ <label>If yes, what types of the procedures you preform?<sup class="text-danger">*</sup></label>
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+ <div class="d-flex flex-column">
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+ <label><input type="checkbox" name="what_types_of_the_procedures_you_preform[]" value="Hemorrhoid Banding" /> <span>Hemorrhoid Banding</span></label>
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+ <label><input type="checkbox" name="what_types_of_the_procedures_you_preform[]" value="Infrared Coagulation" /> <span>Infrared Coagulation</span></label>
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+ <label><input type="checkbox" name="what_types_of_the_procedures_you_preform[]" value="Sclerotherapy" /> <span>Sclerotherapy</span></label>
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+ <label><input type="checkbox" name="what_types_of_the_procedures_you_preform[]" value="Hemorrhoid stapling" /> <span>Hemorrhoid stapling</span></label>
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+ <label><input type="checkbox" name="what_types_of_the_procedures_you_preform[]" value="Hemorrhoidectomy" /> <span>Hemorrhoidectomy</span></label>
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+ </div>
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+ </div>
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- </div>
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- </div>
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- <div class="row mb-3">
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- <div class="col-12 question">
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- <div class="form-group">
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- <label>Have you ever tried or used banding technics using Rubber band ligation?</label>
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- <div class="d-flex flex-column">
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- <label><input type="radio" name="used_banding_technics_using_rubber_band_ligation" v-model="form.used_banding_technics_using_rubber_band_ligation" value="YES" /> <span>Yes</span></label>
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- <label><input type="radio" name="used_banding_technics_using_rubber_band_ligation" v-model="form.used_banding_technics_using_rubber_band_ligation" value="NO" /> <span>No</span></label>
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- </div>
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- </div>
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- <div v-if="form.used_banding_technics_using_rubber_band_ligation == 'YES'" class="form-group">
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- <label>If yes, what is your experience with RBL treatment for hemorrhoids?<sup class="text-danger">*</sup></label>
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- <textarea class="form-control" name="experience_with_rbl_treatment_for_hemorrhoids"></textarea>
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- </div>
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- <div v-if="form.used_banding_technics_using_rubber_band_ligation == 'NO'" class="form-group">
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- <label>If No, Would you like to learn more about hemorroidal treatment option using rubber band ligation?<sup class="text-danger">*</sup></label>
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- <div class="d-flex flex-column">
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- <label><input type="radio" name="interested_to_learn_more_about_hemorroidal_treatment_option_using_rubber_band_ligation" value="YES" /> <span>Yes</span></label>
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- <label><input type="radio" name="interested_to_learn_more_about_hemorroidal_treatment_option_using_rubber_band_ligation" value="NO" /> <span>No</span></label>
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- <label><input type="radio" name="interested_to_learn_more_about_hemorroidal_treatment_option_using_rubber_band_ligation" value="NOT SURE" /> <span>Not sure</span></label>
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- </div>
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- </div>
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+ </div>
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+ </div>
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+ <div class="row mb-3">
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+ <div class="col-12 question">
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+ <div class="form-group">
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+ <label>Have you ever tried or used banding technics using Rubber band ligation?</label>
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+ <div class="d-flex">
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+ <label class="me-3"><input type="radio" name="used_banding_technics_using_rubber_band_ligation" v-model="form.used_banding_technics_using_rubber_band_ligation" value="YES" /> <span>Yes</span></label>
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|
+ <label class="me-3"><input type="radio" name="used_banding_technics_using_rubber_band_ligation" v-model="form.used_banding_technics_using_rubber_band_ligation" value="NO" /> <span>No</span></label>
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|
|
+ </div>
|
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|
+ </div>
|
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|
+ <div v-if="form.used_banding_technics_using_rubber_band_ligation == 'YES'" class="form-group">
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+ <label>If yes, what is your experience with RBL treatment for hemorrhoids?<sup class="text-danger">*</sup></label>
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+ <textarea class="form-control" name="experience_with_rbl_treatment_for_hemorrhoids"></textarea>
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+ </div>
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|
+ <div v-if="form.used_banding_technics_using_rubber_band_ligation == 'NO'" class="form-group">
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+ <label>If No, Would you like to learn more about hemorroidal treatment option using rubber band ligation?<sup class="text-danger">*</sup></label>
|
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+ <div class="d-flex">
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+ <label class="me-3"><input type="radio" name="interested_to_learn_more_about_hemorroidal_treatment_option_using_rubber_band_ligation" value="YES" /> <span>Yes</span></label>
|
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|
+ <label class="me-3"><input type="radio" name="interested_to_learn_more_about_hemorroidal_treatment_option_using_rubber_band_ligation" value="NO" /> <span>No</span></label>
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|
+ <label><input type="radio" name="interested_to_learn_more_about_hemorroidal_treatment_option_using_rubber_band_ligation" value="NOT SURE" /> <span>Not sure</span></label>
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|
+ </div>
|
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|
+ </div>
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|
|
- </div>
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- </div>
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+ </div>
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+ </div>
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|
- <div class="row mb-3">
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|
|
- <div class="col-12 question">
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|
|
- <div class="form-group">
|
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|
- <label>Would you like to recive free samples of the Snyder HemBand?</label>
|
|
|
- <div class="d-flex flex-column">
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|
- <label><input type="radio" name="recive_free_samples_of_the_snyder_hem_band" value="YES" /> <span>Yes</span></label>
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|
- <label><input type="radio" name="recive_free_samples_of_the_snyder_hem_band" value="NO" /> <span>No</span></label>
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|
- </div>
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|
- </div>
|
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|
- </div>
|
|
|
- </div>
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|
+ <div class="row mb-3">
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|
+ <div class="col-12 question">
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|
+ <div class="form-group">
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|
+ <label>Would you like to recive free samples of the Snyder HemBand?</label>
|
|
|
+ <div class="d-flex">
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|
+ <label class="me-3"><input type="radio" name="recive_free_samples_of_the_snyder_hem_band" value="YES" /> <span>Yes</span></label>
|
|
|
+ <label class="me-3"><input type="radio" name="recive_free_samples_of_the_snyder_hem_band" value="NO" /> <span>No</span></label>
|
|
|
+ </div>
|
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|
+ </div>
|
|
|
+ </div>
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|
|
+ </div>
|
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|
- <div class="row mb-3">
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|
- <div class="col-12 question">
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|
- <div class="form-group">
|
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|
- <label>What would be the best way to contact you?</label>
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|
- <div class="d-flex flex-column">
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|
|
- <label><input type="radio" name="best_way_to_contact_you" value="Phone Call" /> <span>Phone call</span></label>
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|
- <label><input type="radio" name="best_way_to_contact_you" value="Email" /> <span>Email</span></label>
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|
- <label><input type="radio" name="best_way_to_contact_you" value="Text" /> <span>Text</span></label>
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|
|
- </div>
|
|
|
- </div>
|
|
|
- </div>
|
|
|
- </div>
|
|
|
+ <div class="row mb-3">
|
|
|
+ <div class="col-12 question">
|
|
|
+ <div class="form-group">
|
|
|
+ <label>What would be the best way to contact you?</label>
|
|
|
+ <div class="d-flex">
|
|
|
+ <label class="me-3"><input type="radio" name="best_way_to_contact_you" value="Phone Call" /> <span>Phone call</span></label>
|
|
|
+ <label class="me-3"><input type="radio" name="best_way_to_contact_you" value="Email" /> <span>Email</span></label>
|
|
|
+ <label><input type="radio" name="best_way_to_contact_you" value="Text" /> <span>Text</span></label>
|
|
|
+ </div>
|
|
|
+ </div>
|
|
|
+ </div>
|
|
|
+ </div>
|
|
|
|
|
|
- <div class="row mb-3">
|
|
|
- <div class="col-12 question">
|
|
|
- <div class="form-group">
|
|
|
- <label>Preferred time to call:</label>
|
|
|
- <div class="d-flex flex-wrap mb-3">
|
|
|
- <label class="me-3 text-muted">Day(s):</label>
|
|
|
- <label class="me-3"><input type="checkbox" name="preferred_day_to_call[]" value="Monday" /> <span>M</span></label>
|
|
|
- <label class="me-3"><input type="checkbox" name="preferred_day_to_call[]" value="Tuesday" /> <span>Tu</span></label>
|
|
|
- <label class="me-3"><input type="checkbox" name="preferred_day_to_call[]" value="Wednesday" /> <span>W</span></label>
|
|
|
- <label class="me-3"><input type="checkbox" name="preferred_day_to_call[]" value="Thursday" /> <span>Th</span></label>
|
|
|
- <label class="me-3"><input type="checkbox" name="preferred_day_to_call[]" value="Friday" /> <span>F</span></label>
|
|
|
- <label class="me-3"><input type="checkbox" name="preferred_day_to_call[]" value="Saturday" /> <span>Sa</span></label>
|
|
|
- <label class="me-3"><input type="checkbox" name="preferred_day_to_call[]" value="Sunday" /> <span>Su</span></label>
|
|
|
- </div>
|
|
|
- <div class="d-flex flex-wrap mb-3">
|
|
|
- <label class="me-3 text-muted">Time(s) <small>(your local time)</small>:</label>
|
|
|
- <label class="me-3"><input type="checkbox" name="preferred_time_to_call[]" value="8-10" /> <span>8-10</span></label>
|
|
|
- <label class="me-3"><input type="checkbox" name="preferred_time_to_call[]" value="10-12" /> <span>10-12</span></label>
|
|
|
- <label class="me-3"><input type="checkbox" name="preferred_time_to_call[]" value="12-2" /> <span>12-2</span></label>
|
|
|
- <label class="me-3"><input type="checkbox" name="preferred_time_to_call[]" value="2-4" /> <span>2-4</span></label>
|
|
|
- <label class="me-3"><input type="checkbox" name="preferred_time_to_call[]" value="4-6" /> <span>4-6</span></label>
|
|
|
- </div>
|
|
|
- </div>
|
|
|
- </div>
|
|
|
- </div>
|
|
|
+ <div class="row mb-3">
|
|
|
+ <div class="col-12 question">
|
|
|
+ <div class="form-group">
|
|
|
+ <label>Preferred time to call:</label>
|
|
|
+ <div class="d-flex flex-wrap mb-3">
|
|
|
+ <label class="me-3 text-muted">Day(s):</label>
|
|
|
+ <label class="me-3"><input type="checkbox" name="preferred_day_to_call[]" value="Monday" /> <span>M</span></label>
|
|
|
+ <label class="me-3"><input type="checkbox" name="preferred_day_to_call[]" value="Tuesday" /> <span>Tu</span></label>
|
|
|
+ <label class="me-3"><input type="checkbox" name="preferred_day_to_call[]" value="Wednesday" /> <span>W</span></label>
|
|
|
+ <label class="me-3"><input type="checkbox" name="preferred_day_to_call[]" value="Thursday" /> <span>Th</span></label>
|
|
|
+ <label class="me-3"><input type="checkbox" name="preferred_day_to_call[]" value="Friday" /> <span>F</span></label>
|
|
|
+ <label class="me-3"><input type="checkbox" name="preferred_day_to_call[]" value="Saturday" /> <span>Sa</span></label>
|
|
|
+ <label class="me-3"><input type="checkbox" name="preferred_day_to_call[]" value="Sunday" /> <span>Su</span></label>
|
|
|
+ </div>
|
|
|
+ <div class="d-flex flex-wrap mb-3">
|
|
|
+ <label class="me-3 text-muted">Time(s) <small>(your local time)</small>:</label>
|
|
|
+ <label class="me-3"><input type="checkbox" name="preferred_time_to_call[]" value="8-10" /> <span>8-10</span></label>
|
|
|
+ <label class="me-3"><input type="checkbox" name="preferred_time_to_call[]" value="10-12" /> <span>10-12</span></label>
|
|
|
+ <label class="me-3"><input type="checkbox" name="preferred_time_to_call[]" value="12-2" /> <span>12-2</span></label>
|
|
|
+ <label class="me-3"><input type="checkbox" name="preferred_time_to_call[]" value="2-4" /> <span>2-4</span></label>
|
|
|
+ <label class="me-3"><input type="checkbox" name="preferred_time_to_call[]" value="4-6" /> <span>4-6</span></label>
|
|
|
+ </div>
|
|
|
+ </div>
|
|
|
+ </div>
|
|
|
+ </div>
|
|
|
|
|
|
- <div class="row mb-3">
|
|
|
- <div class="col-12 question">
|
|
|
- <div class="form-group">
|
|
|
- <label>Your comments</label>
|
|
|
- <textarea name="your_comments" class="form-control"></textarea>
|
|
|
- </div>
|
|
|
- </div>
|
|
|
- </div>
|
|
|
+ <div class="row mb-3">
|
|
|
+ <div class="col-12 question">
|
|
|
+ <div class="form-group">
|
|
|
+ <label>Your comments</label>
|
|
|
+ <textarea name="your_comments" class="form-control"></textarea>
|
|
|
+ </div>
|
|
|
+ </div>
|
|
|
+ </div>
|
|
|
|
|
|
- <div class="row mt-3">
|
|
|
- <div class="col-md-12">
|
|
|
- <div class="form-group mb-4">
|
|
|
- {!! htmlFormSnippet() !!}
|
|
|
- @error('g-recaptcha-response')
|
|
|
- <small class="text-danger"><i class="fas fa-exclamation-triangle mr-2"></i>Invalid</small>
|
|
|
- @enderror
|
|
|
- </div>
|
|
|
- </div>
|
|
|
- <div class="col-12">
|
|
|
- <button type="submit" class="btn btn-pry w-100 py-3">SUBMIT</button>
|
|
|
- </div>
|
|
|
- </div>
|
|
|
- </form>
|
|
|
- </div>
|
|
|
- @endif
|
|
|
+ <div class="row mt-3">
|
|
|
+ <div class="col-md-12">
|
|
|
+ <div class="form-group mb-4">
|
|
|
+ {!! htmlFormSnippet() !!}
|
|
|
+ @error('g-recaptcha-response')
|
|
|
+ <small class="text-danger"><i class="fas fa-exclamation-triangle mr-2"></i>Invalid</small>
|
|
|
+ @enderror
|
|
|
+ </div>
|
|
|
+ </div>
|
|
|
+ <div class="col-12">
|
|
|
+ <button type="submit" class="btn btn-pry w-100 py-3">SUBMIT</button>
|
|
|
+ </div>
|
|
|
+ </div>
|
|
|
+ </form>
|
|
|
+ </div>
|
|
|
+ @endif
|
|
|
+ </div>
|
|
|
+ </div>
|
|
|
</div>
|
|
|
+ </div>
|
|
|
</div>
|
|
|
|
|
|
<script>
|
|
|
@@ -326,4 +332,4 @@
|
|
|
});
|
|
|
</script>
|
|
|
|
|
|
-@endsection
|
|
|
+@endsection
|
Peter Muturi