@include('admin.includes.head')
@include('admin.includes.sidebar')
@include('admin.includes.topbar')
<style>
    .input-group> :not(:first-child):not(.dropdown-menu):not(.valid-tooltip):not(.valid-feedback):not(.invalid-tooltip):not(.invalid-feedback) {
        padding-bottom: 8px;
    }

    .customeWidth {
        width: 18%;
    }
</style>
<!-- ======= Service Request ======= -->
<div class="container">
    <div class="row px-4 pb-4 pt-0">
        <div class="col-md-12 mx-auto d-block card shadow-lg my-2">
            @if (session()->has('success'))
                {!! session('success') !!}
            @endif

            <form action="{{ route('admin.service-request') }}" method="post" id="serviceRequestForm">
                @csrf
                <fieldset class="border-2">
                    <legend class="legend-outer  float-none w-auto"> Request a Service </legend>


                    <fieldset class="border-2">
                        <div class="row justify-content-between m-0 p-0">
                            <div class="col-md-2 customeWidth m-0 p-0">
                                <fieldset class="border">
                                    <legend class="legend-inner float-none w-auto required">First Name<span
                                            class="text-danger fw-bold" style="font-size: 20px;">*</span></legend>
                                    <div class="input-group">
                                        <i class="fa fa-user fa2"></i>
                                        <input type="text" class="form-control border-dark"
                                            style="color:black!important;" name="fname" id="fname"
                                            placeholder="First Name*"
                                            value="{{ old('fname', isset($firstname) ? $firstname : '') }}" required
                                            readonly>

                                    </div>
                                </fieldset>
                            </div>
                            <div class="col-md-2 customeWidth m-0 p-0">
                                <fieldset class="border">
                                    <legend class="legend-inner float-none w-auto required">Last Name<span
                                            class="text-danger fw-bold" style="font-size: 20px;">*</span></legend>
                                    <div class="input-group">
                                        <i class="fa fa-user fa2"></i>
                                        @php
                                            $lastNameValue = old('lname', isset($lastname) ? $lastname : '');
                                            $readonlyAttribute = empty($lastNameValue) ? '' : 'readonly';
                                        @endphp

                                        <input type="text" class="form-control border-dark" name="lname"
                                            id="lname" placeholder="Last Name"
                                            value="{{ old('lname', isset($lastname) ? $lastname : '') }}"
                                            {{ $readonlyAttribute }} required>

                                    </div>
                                </fieldset>
                            </div>

                            <div class="col-md-2 customeWidth m-0 p-0">
                                <fieldset class="border">
                                    <legend class="legend-inner float-none w-auto required">Gotra</legend>
                                    <div class="input-group">
                                        <i class="fa fa-user fa2"></i>
                                        <input type="text" class="form-control border-dark"
                                            style="color:black!important;" id="gotra" name="gotra"
                                            placeholder="Gotra"
                                            value="{{ old('gotra', isset($userDetails->gotraName) ? $userDetails->gotraName : '') }}">

                                    </div>
                                </fieldset>
                            </div>
                            <div class="col-md-2 customeWidth m-0 p-0">
                                <fieldset class="border">
                                    <legend class="legend-inner float-none w-auto required">Nakshatra</legend>
                                    <div class="input-group">
                                        <i class="fa fa-user fa2"></i>
                                        <input type="text" class="form-control border-dark" name="stars"
                                            placeholder="Nakshatra"
                                            value="{{ old('stars', isset($userDetails->Nakshtra) ? $userDetails->Nakshtra : '') }}"
                                            style="color:black!important;">

                                    </div>
                                </fieldset>
                            </div>
                            <div class="col-md-2 customeWidth m-0 p-0">
                                <fieldset class="border">
                                    <legend class="legend-inner float-none w-auto required">Rashi</legend>
                                    <div class="input-group">
                                        <i class="fa fa-user fa2"></i>
                                        <input type="text" class="form-control border-dark" name="rashi"
                                            placeholder="Rashi"
                                            value="{{ old('rashi', isset($userDetails->rashi) ? $userDetails->rashi : '') }}"
                                            style="color:black!important;">

                                    </div>
                                </fieldset>
                            </div>
                        </div>




                        <div class="row">
                            <div class="col-md-6">
                                <fieldset class="border">
                                    <legend class="legend-inner float-none w-auto required">Street Address<span
                                            class="text-danger fw-bold" style="font-size: 20px;">*</span></legend>
                                    <div class="input-group">
                                        <input type="text" class="form-control border-dark" name="streetAddress"
                                            id="streetAddress" placeholder="Street Address*"
                                            style="color:black!important;" required
                                            value="{{ old('streetAddress', isset($userDetails->county) ? $userDetails->county : '') }}">

                                    </div>
                                </fieldset>
                            </div>
                            <div class="col-md-3">
                                @php
                                    $fieldset_bg =
                                        isset($userDetails->email) && !empty($userDetails->email)
                                            ? 'readonly style="background-color: #e7e6e6;"'
                                            : '';
                                @endphp

                                <fieldset class="border" {!! $fieldset_bg !!}>
                                    <legend class="legend-inner float-none w-auto required">Email<span
                                            class="text-danger fw-bold" style="font-size: 20px;">*</span></legend>
                                    <div class="input-group">
                                        <i class="fa fa-envelope fa2"></i>
                                        <input type="email" class="form-control border-dark" id="email"
                                            name="email" placeholder="Email ID*"
                                            value="{{ old('email', isset($userDetails->email) ? base64_decode($userDetails->email) : '') }}"
                                            {!! $fieldset_bg !!} required>
                                    </div>
                                </fieldset>

                            </div>
                            <div class="col-md-3">
                                @php
                                    $fieldset_bg2 =
                                        isset($userDetails->phone) && !empty($userDetails->phone)
                                            ? 'readonly style="background-color: #e7e6e6;color:black!important;"'
                                            : 'style="color:black!important;"';
                                @endphp

                                <fieldset class="border" {!! $fieldset_bg2 !!}>
                                    <legend class="legend-inner float-none w-auto required">Phone<span
                                            class="text-danger fw-bold" style="font-size: 20px;">*</span></legend>
                                    <div class="input-group">
                                        <i class="fa fa-phone fa2"></i>
                                        <input type="text" class="form-control border-dark" name="phoneNumber"
                                            placeholder="Phone Number*"
                                            value="{{ old('phoneNumber', isset($userDetails->phone) ? formatPhoneNumber(base64_decode($userDetails->phone)) : '') }}"
                                            {!! $fieldset_bg2 !!} required>
                                    </div>
                                </fieldset>

                            </div>
                        </div>
                    </fieldset>

                    <div class="col-md-4 d-none">
                        <fieldset class="border">
                            <legend class="legend-inner float-none w-auto required">State<span
                                    class="text-danger fw-bold" style="font-size: 20px;">*</span></legend>
                            <div class="input-group">
                                <input type="text" name="state" id="state" class="form-control"
                                    placeholder="State"
                                    value="{{ old('state', isset($userDetails->stateTypes) ? $userDetails->stateTypes : '') }}">

                            </div>
                        </fieldset>
                    </div>
                    <div class="col-md-4 d-none">
                        <fieldset class="border">
                            <legend class="legend-inner float-none w-auto required">City<span
                                    class="text-danger fw-bold" style="font-size: 20px;">*</span></legend>
                            <div class="input-group">
                                <input type="text" name="city" id="city" class="form-control"
                                    placeholder="City"
                                    value="{{ old('city', isset($userDetails->cityTypes) ? $userDetails->cityTypes : '') }}">

                            </div>
                        </fieldset>
                    </div>

                    <div class="col-md-4 d-none">
                        <fieldset class="border">
                            <legend class="legend-inner float-none w-auto required">Zip Code<span
                                    class="text-danger fw-bold" style="font-size: 20px;">*</span></legend>
                            <div class="input-group">
                                <input type="text" class="form-control border-dark" style="color:black!important;"
                                    name="zipcode" id="zipcode" placeholder="Zip Code*"
                                    value="{{ old('zipcode', isset($userDetails->zip) ? $userDetails->zip : '') }}"
                                    required>

                            </div>
                        </fieldset>
                    </div>

                    <fieldset class="border-2">
                        <div class="row">
                            <div class="col-md-4">
                                <fieldset class="border">
                                    <legend class="legend-inner float-none w-auto required">Preferred Location<span
                                            class="text-danger fw-bold" style="font-size: 20px;">*</span></legend>
                                    <div class="input-group">
                                        <select name="preferredLocation" id="preferredLocation"
                                            style="color:black!important;" class="form-control rounded form-select"
                                            required>
                                            <option value="" selected style="color:black!important;">Preferred
                                                Location</option>
                                            @php
                                                $preferredLocations = array_reverse($preferredLocations);
                                            @endphp
                                            @foreach ($preferredLocations as $item)
                                                @php
                                                    $catName = '';
                                                    switch ($item->refDataName) {
                                                        case 'IN-TEMPLE':
                                                            $catName = 'IN TEMPLE';
                                                            break;
                                                        case 'SHRAADHAM':
                                                            $catName = 'APARAKARYA';
                                                            break;
                                                        case 'AWAY-TEMPLE':
                                                            $catName = 'OUTSIDE TEMPLE';
                                                            break;
                                                        default:
                                                            $catName = $item->refDataName;
                                                            break;
                                                    }
                                                @endphp
                                                <option value="{{ $item->refDataName }}">{{ $catName }}</option>
                                            @endforeach
                                        </select>

                                    </div>
                                </fieldset>
                            </div>
                            <div class="col-md-4">
                                <fieldset class="border">
                                    <legend class="legend-inner float-none w-auto required">Service<span
                                            class="text-danger fw-bold" style="font-size: 20px;">*</span></legend>
                                    <div class="input-group">
                                        <select name="serviceName" id="serviceName" style="color:black!important;"
                                            class="form-control rounded  form-select" required>
                                            <option value=" " selected disabled>Select Service</option>
                                        </select>
                                        <input type="hidden" id="serviceType" name="serviceType">
                                        <input type="hidden" id="serviceAmount" name="serviceAmount">
                                        <input type="hidden" name="serviceId" id="serviceId">
                                    </div>
                                </fieldset>
                            </div>

                            <div class="col-md-4">
                                <fieldset class="border">
                                    <legend class="legend-inner float-none w-auto required">Service Amount<span
                                            class="text-danger fw-bold" style="font-size: 20px;">*</span></legend>
                                    <div class="input-group">
                                        <i class="fa fa-location fa2"></i>
                                        <input type="text" class="form-control rounded" id="serviceAmountBox"
                                            placeholder="Service Amount*" value="" readonly required>
                                    </div>
                                </fieldset>
                            </div>
                            <div class="col-md-12" style="display: none;" id="serviceDetailsBox">


                            </div>




                            <div class="col-md-4 d-none">
                                <fieldset class="border">
                                    <legend class="legend-inner float-none w-auto required">Preferred Language<span
                                            class="text-danger fw-bold" style="font-size: 20px;">*</span></legend>
                                    <div class="input-group">
                                        <select name="preferredLanguage" id="preferredLanguage"
                                            style="color:black!important;" class="form-control rounded  form-select">
                                            <option value=" " selected disabled>Select Preferred Language</option>
                                                                                    </select>
                                    </div>
                                </fieldset>
                            </div>

                            <div class="col-md-6">
                                <fieldset class="border">
                                    <legend class="legend-inner float-none w-auto required">Priests<span
                                            class="text-danger fw-bold" style="font-size: 20px;">*</span></legend>
                                    <div class="input-group">
                                        <select name="priestName" id="priestName" style="color:black!important;"
                                            class="form-control rounded form-select" required>
                                            @if ($PriestData != '')
                                                <option value="" selected disabled>Select Preferred Priest
                                                </option>
                                                @foreach ($PriestData as $item)
                                                    <option value="{{ @$item->refDataName }}"
                                                        email="{{ base64_decode(@$item->email) }}"
                                                        phone="{{ base64_decode(@$item->phone) }}"
                                                        priestID="{{ @$item->_id }}"
                                                        {{ @$userDetails->requestForPriestName ? 'selected' : '' }}>
                                                        {{ @$item->refDataName }}
                                                    </option>
                                                @endforeach
                                            @else
                                                <option value="" selected disabled>Priest Not Available.</option>
                                            @endif
                                            <option value="Any Priest" email="" phone="" priestId="0">
                                                Any Priest</option>
                                        </select>

                                        <input type="hidden" name="priestPhone" id="priestPhone"
                                            value="{{ json_decode(@$userDetails->priestPhone) }}">
                                        <input type="hidden" name="priestEmail" id="priestEmail"
                                            value="{{ json_decode(@$userDetails->priestEmail) }}">
                                        <input type="hidden" name="priestId" id="priestId"
                                            value="{{ @$userDetails->requestedPriestId }}">

                                    </div>

                                </fieldset>
                            </div>
                            <div class="col-md-6"
                                style="display: flex; align-items: center; flex-direction: row-reverse;">
                                <div class="form-check form-check-inline mx-4">
                                    <input class="form-check-input" type="checkbox" id="inlineCheckbox"
                                        name="confirmByPriest">
                                    <label class="form-check-label"
                                        style="padding-top: 10px !important;  padding-left: 20px;"
                                        for="inlineCheckbox">Already Confirmed By Priest</label>
                                </div>
                            </div>

                            <div class="col-md-4">
                                <fieldset class="border">
                                    <legend class="legend-inner float-none w-auto required">Service Date<span
                                            class="text-danger fw-bold" style="font-size: 20px;">*</span></legend>
                                    <div class="input-group">
                                        <i class="fa fa-calendar fa2"></i>
                                        <input placeholder="MM/DD/YYYY" class="form-control rounded "
                                            id="serviceDate" name="serviceDate" type="text" readonly required>
                                    </div>
                                </fieldset>
                            </div>
                            <div class="col-md-4">
                                <fieldset class="border">
                                    <legend class="legend-inner float-none w-auto required">Service Time</legend>
                                    <div class="input-group">
                                        <i class="fa fa-clock-o fa2"></i>

                                        <input type='text' class='form-control' name="serviceTime"
                                            id="serviceTime" placeholder='00:00'>

                                    </div>
                                </fieldset>

                            </div>

                            <div class="col-md-4">
                                <fieldset class="border">
                                    <legend class="legend-inner float-none w-auto required">Select Venue<span
                                            class="text-danger fw-bold" style="font-size: 20px;">*</span></legend>
                                    <div class="input-group">
                                        <select name="selectVenue" id="selectVenue" style="color:black!important;"
                                            class="form-control rounded  form-select" required>
                                            <option value=" " selected disabled>Select Venue</option>
                                            <option value="Same as Home Address">Same as Home Address</option>
                                            <option value="Same as Temple Address">Same as Temple Address</option>
                                            <option value="Other">Other</option>
                                        </select>

                                    </div>
                                </fieldset>

                            </div>

                            <div class="col-md-12">
                                <fieldset class="border" id="serviceAddressBox">
                                    <legend class="legend-inner float-none w-auto required">Full Address<span
                                            class="text-danger fw-bold" style="font-size: 20px;">*</span></legend>
                                    <div class="input-group">
                                        <i class="fa fa-location fa2"></i>
                                        <input type="text" class="form-control rounded " name="serviceAddress"
                                            id="serviceAddress" placeholder="Please enter your address*"
                                            value="" required>
                                    </div>
                                </fieldset>
                            </div>

                            <div class="col-md-12">
                                <fieldset class="border">
                                    <legend class="legend-inner float-none w-auto">Additional Info</legend>
                                    <div class="input-group">
                                        <textarea type="textarea" name="addtionalInfo" class="form-control border-dark rounded form-text-area"
                                            placeholder="Please provide any additional details here."></textarea>
                                    </div>
                                </fieldset>
                            </div>
                        </div>
                    </fieldset>
            </form>

        </div>

    </div>
</div>
</div>