Fixes

app/Http/Controllers/AppController.php

@@ -52,7 +52,9 @@ class AppController extends Controller
 
     public function submitGiSurveyQuestions(Request $request){
       $request->validate([
-        'name' => 'required|string',
+        'first_name' => 'required|string',
+        'last_name' => 'required|string',
+        'phone_number' => 'required|string',
         'email' => 'required|email',
         'g-recaptcha-response' => 'required|recaptcha'
       ]);

resources/views/app/gi-survey-questions.blade.php

@@ -7,6 +7,7 @@
     .text-success-light {
         color: #70bb70;
     }
+
     .form-group label {
         font-weight: 500;
     }
@@ -123,9 +124,8 @@
                     @if (session('success'))
                     <div class="col-12">
                         <div class="alert alert-success" role="alert">
-                            <h4 class="alert-heading">Congratulations!!</h4>
-                            <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>
+                            <h4 class="alert-heading">Thank you!</h4>
+                            <p>We have received your form submission and will process it promptly.</p>
                         </div>
                     </div>
                     @else
@@ -197,17 +197,27 @@
                             <div class="row mb-3">
                                 <div class="col-12 question">
                                     <div class="form-group">
-                                        <label>What is the best phone number to reach you at to take a 5 minute telephone survey?</label>
-                                        <input type="text" class="form-control phone" name="phone_number" value="{{ old('phone_number') }}" />
+                                        <label>What is the best phone number to reach you at to take a 5 minute telephone survey?<sup class="text-danger">*</sup></label>
+                                        <input type="tel" class="form-control" name="phone_number" value="{{ old('phone_number') }}" required />
                                     </div>
                                 </div>
                             </div>
 
                             <div class="row mb-3">
                                 <div class="col-12 question">
-                                    <div class="form-group">
-                                        <label>Your Name<sup class="text-danger">*</sup></label>
-                                        <input type="text" class="form-control" name="name" value="{{ old('name') }}" required />
+                                    <div class="row">
+                                        <div class="col-md-6">
+                                            <div class="form-group">
+                                                <label>Your First Name<sup class="text-danger">*</sup></label>
+                                                <input type="text" class="form-control" name="first_name" value="{{ old('first_name') }}" required />
+                                            </div>
+                                        </div>
+                                        <div class="col-md-6">
+                                            <div class="form-group">
+                                                <label>Your Last Name<sup class="text-danger">*</sup></label>
+                                                <input type="text" class="form-control" name="last_name" value="{{ old('last_name') }}" required />
+                                            </div>
+                                        </div>
                                     </div>
                                 </div>
                             </div>
@@ -215,7 +225,7 @@
                             <div class="row mb-3">
                                 <div class="col-12 question">
                                     <div class="form-group">
-                                        <label>What state do you practice in:</label>
+                                        <label>What state do you practice in?</label>
                                         <select class="form-control" name="practice_address_state">
                                             <option value=""></option>
                                             @foreach(config('constants.us_states') as $stateKey => $stateLabel)
@@ -270,11 +280,13 @@
                                             <div class="d-flex flex-column flex-md-row flex-wrap mt-1">
                                                 <?php
                                                 $preferred_time_to_call = [
-                                                    '8-10',
-                                                    '10-12',
-                                                    '12-2',
-                                                    '2-4',
-                                                    '4-6'
+                                                    '6-8 am',
+                                                    '8-10 am',
+                                                    '10-12 pm',
+                                                    '12-2 pm',
+                                                    '2-4 pm',
+                                                    '4-6 pm',
+                                                    '6-8 pm'
                                                 ];
                                                 ?>
                                                 @foreach($preferred_time_to_call as $time)
@@ -287,6 +299,9 @@
                                                 </div>
                                                 @endforeach
                                             </div>
+                                            <div class="mt-3">
+                                                <input type="text" class="form-control" name="any_other_special_time" value="{{ old('any_other_special_time') }}" placeholder="Any other special time" />
+                                            </div>
                                             <small class="text-muted mt-1"><i class="fa-duotone fa-circle-info fa-fw"></i> Your local time</small>
                                         </div>
                                     </div>