56 lines
2.4 KiB
Plaintext
56 lines
2.4 KiB
Plaintext
<div class="card shadow-sm">
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<div class="card-body">
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<%= errors_summary_for @medical_release %>
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<%= bootstrap_form_with model: [@account, @project, @contract_template, @medical_release], local: true, validation_context: :native do |form| %>
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<div class="alert alert-warning font-weight-bold"><%= t ".instructions_html", name: @project.name %></div>
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<%= card_field_set_tag t(".legal.heading") do %>
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<p><%= @contract_template.body %></p>
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<% if @contract_template.fee? %>
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<p>
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Fee <span class="font-weight-bold text-success"><%= number_to_currency @contract_template.fee %></span>
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</p>
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<% end %>
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<% end %>
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<hr>
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<% if (1..10).map {|n| @contract_template.public_send("question_#{n}_text").presence }.compact.any? %>
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<%= card_field_set_tag t(".questionnaire.heading") do %>
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<% (1..10).each do |n| %>
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<% if @contract_template.public_send("question_#{n}_text").present? %>
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<div class="form-row">
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<%= form.text_area "question_#{n}_answer", wrapper_class: "col-sm-12", label: @contract_template.public_send("question_#{n}_text") %>
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</div>
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<% end %>
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<% end %>
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<% end %>
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<hr>
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<% end %>
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<%= card_field_set_tag t(".personal_info.heading") do %>
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<div class="alert alert-warning font-weight-bold"><%= t ".personal_info.instructions" %></div>
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<div class="form-row">
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<%= form.text_field :person_first_name, required: true, wrapper_class: "col-sm-6" %>
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<%= form.text_field :person_last_name, required: true, wrapper_class: "col-sm-6" %>
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<%= form.phone_field :person_phone, wrapper_class: "col-sm-6" %>
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<%= form.email_field :person_email, wrapper_class: "col-sm-6" %>
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</div>
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<%= render "shared/address_fields", form: form, subject: "person" %>
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<% end %>
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<hr>
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<%= card_field_set_tag t(".photo.heading") do %>
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<%= render "shared/photos_dropzone_fields", form: form, release: @medical_release %>
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<% end %>
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<%= card_field_set_tag t(".signature.heading") do %>
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<%= render "shared/signature_fields", form: form %>
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<% end %>
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<div class="mt-5">
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<%= form.button t("shared.submit_release_short"), class: "btn btn-block btn-lg btn-success", data: { disable_with: t("shared.disable_with") } %>
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</div>
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<% end %>
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</div>
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</div> |