@extends('layouts.public')
@section('content')
<section class="hms-section"><div class="hms-container grid gap-12 lg:grid-cols-[.8fr_1.2fr]"><div><p class="hms-kicker">Contact</p><h1 class="hms-display mt-2">How can we help?</h1><p class="mt-5 text-black/65">Send a general business inquiry. Please do not include medical records, diagnosis information, patient identification numbers, government identification numbers, or other sensitive health information.</p></div><div class="rounded-3xl border border-black/10 bg-white p-7 shadow-sm">@if(session('success'))<div class="mb-6 rounded-xl bg-green-50 p-4 text-green-900" role="status">{{ session('success') }}</div>@endif@if($errors->any())<div class="mb-6 rounded-xl bg-red-50 p-4 text-red-900" role="alert"><strong>Please correct the highlighted fields.</strong></div>@endif<form method="POST" action="{{ route('contact.store') }}" class="grid gap-5">@csrf<div class="grid gap-5 sm:grid-cols-2"><label class="grid gap-2 text-sm font-semibold">Name<input class="rounded-xl border border-black/15 px-4 py-3" name="name" value="{{ old('name') }}" required>@error('name')<span class="text-red-700">{{ $message }}</span>@enderror</label><label class="grid gap-2 text-sm font-semibold">Email<input class="rounded-xl border border-black/15 px-4 py-3" type="email" name="email" value="{{ old('email') }}" required>@error('email')<span class="text-red-700">{{ $message }}</span>@enderror</label></div><div class="grid gap-5 sm:grid-cols-2"><label class="grid gap-2 text-sm font-semibold">Phone <span class="font-normal text-black/45">optional</span><input class="rounded-xl border border-black/15 px-4 py-3" name="phone" value="{{ old('phone') }}"></label><label class="grid gap-2 text-sm font-semibold">Topic<input class="rounded-xl border border-black/15 px-4 py-3" name="topic" value="{{ old('topic') }}"></label></div><label class="grid gap-2 text-sm font-semibold">Message<textarea class="min-h-40 rounded-xl border border-black/15 px-4 py-3" name="message" required>{{ old('message') }}</textarea>@error('message')<span class="text-red-700">{{ $message }}</span>@enderror</label><div class="hidden" aria-hidden="true"><label>Company website<input tabindex="-1" autocomplete="off" name="company_website"></label></div><label class="flex items-start gap-3 text-sm"><input class="mt-1" type="checkbox" name="privacy_acknowledgement" value="1" required><span>I understand this form is for general business communication and should not contain sensitive health or identification information.</span></label>@error('privacy_acknowledgement')<span class="text-sm text-red-700">{{ $message }}</span>@enderror<button class="hms-button hms-button-primary justify-center" type="submit">Send message</button></form></div></div></section>
@endsection