survey-questions.blade.php 6.8 KB

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  1. @extends('layouts.app')
  2. @section('content')
  3. <link rel="stylesheet" href="{{ asset('css/nouislider.min.css') }}" />
  4. <script src="{{ asset('js/nouislider.min.js') }}"></script>
  5. <style>
  6. .form-group label {
  7. font-weight: 500;
  8. }
  9. .form-group label span {
  10. font-weight: 400;
  11. }
  12. .noUiSlider {
  13. margin: 58px 0;
  14. padding: 0 15px;
  15. }
  16. </style>
  17. <div class="bg-light">
  18. <div class="container pt-3">
  19. <nav class="mb-0">
  20. <ol class="breadcrumb">
  21. <li class="breadcrumb-item"><a href="{{route('index')}}"><u>Home</u></a></li>
  22. <li class="breadcrumb-item active" aria-current="page">Survey Questions</li>
  23. </ol>
  24. </nav>
  25. </div>
  26. </div>
  27. <div class="bg-grey py-5">
  28. <div class="container">
  29. <div class="row justify-content-center">
  30. <div class="col-lg-7 text-center">
  31. <h5 class="subtitle">Survey Questions</h5>
  32. </div>
  33. </div>
  34. </div>
  35. </div>
  36. <div class="container py-5">
  37. <div class="row justify-content-center">
  38. <div id="surveyQuestionsComponent" class="col-md-12">
  39. <form action="{{ route('submit-survey-questions') }}" method="POST">
  40. @csrf
  41. <div class="row mb-3">
  42. <div class="col-12">
  43. <div class="bg-light border p-3">
  44. <div class="row">
  45. <div class="col-md-4">
  46. <div class="form-group">
  47. <label>Name<sup class="text-danger">*</sup></label>
  48. <input type="text" class="form-control" name="name" required />
  49. </div>
  50. </div>
  51. <div class="col-md-4">
  52. <div class="form-group">
  53. <label>Email</label>
  54. <input type="email" class="form-control" name="email" />
  55. <small class="text-muted">(to receive digital gift card)</small>
  56. </div>
  57. </div>
  58. <div class="col-md-4">
  59. <div class="form-group">
  60. <label>Cell Number</label>
  61. <input type="text" class="form-control" name="cellNumber" />
  62. </div>
  63. </div>
  64. <div class="col-md-12">
  65. <div class="form-group">
  66. <label>Practice Address</label>
  67. <input type="text" class="form-control" name="practiceAddress" />
  68. </div>
  69. </div>
  70. </div>
  71. </div>
  72. </div>
  73. </div>
  74. <div class="row mb-3">
  75. <div class="col-12 question">
  76. <div class="form-group">
  77. <label>Are you a gastroenterologist?</label>
  78. <div class="d-flex flex-column">
  79. <label><input type="radio" name="are_you_a_gastroenterologist" v-model="form.are_you_a_gastroenterologist" value="YES" /> <span>Yes</span></label>
  80. <label><input type="radio" name="are_you_a_gastroenterologist" v-model="form.are_you_a_gastroenterologist" value="NO" /> <span>No</span></label>
  81. </div>
  82. </div>
  83. <div v-if="form.are_you_a_gastroenterologist == 'NO'" class="form-group">
  84. <label>Your speciality?<sup class="text-danger">*</sup></label>
  85. <input type="text" class="form-control" name="your_specialty" required />
  86. </div>
  87. </div>
  88. </div>
  89. <div class="row mb-3">
  90. <div class="col-12 question">
  91. <div class="form-group">
  92. <label>Years in practice</label>
  93. <div id="rangeSlider" class="noUiSlider"></div>
  94. <input type="hidden" name="years_in_practice" :value="form.years_in_practice" />
  95. </div>
  96. </div>
  97. </div>
  98. <div class="row mb-3">
  99. <div class="col-12 question">
  100. <div class="form-group">
  101. <label>Where do you perform your regular procedures?</label>
  102. <div class="d-flex flex-column">
  103. <!-- <label><input type="checkbox"></label> -->
  104. </div>
  105. </div>
  106. </div>
  107. </div>
  108. <div class="row mt-3">
  109. <div class="col-12">
  110. <button type="submit" class="btn btn-pry w-100 py-3">SUBMIT</button>
  111. </div>
  112. </div>
  113. </form>
  114. </div>
  115. </div>
  116. </div>
  117. <script>
  118. var surveyQuestionsComponent = new Vue({
  119. el: '#surveyQuestionsComponent',
  120. data: {
  121. form: {
  122. are_you_a_gastroenterologist: null,
  123. years_in_practice: 0
  124. }
  125. },
  126. methods: {
  127. initRangeSlider: function() {
  128. var self = this;
  129. var slider = document.getElementById('rangeSlider');
  130. var format = {
  131. to: function(value) {
  132. return Math.round(value);
  133. },
  134. from: function(value) {
  135. return Math.round(value);
  136. }
  137. };
  138. noUiSlider.create(slider, {
  139. start: 0,
  140. connect: 'lower',
  141. range: {
  142. 'min': 0,
  143. 'max': 70
  144. },
  145. step: 1,
  146. tooltips: true,
  147. format: format,
  148. pips: {
  149. mode: 'steps',
  150. format: format
  151. },
  152. });
  153. slider.noUiSlider.on('update', function(values, handle) {
  154. self.form.years_in_practice = values[0];
  155. });
  156. },
  157. init: function() {
  158. this.initRangeSlider();
  159. }
  160. },
  161. mounted: function() {
  162. this.init();
  163. }
  164. });
  165. </script>
  166. @endsection