templates/front_v4/mca/landing_page/form/_form_lp_prospect.html.twig line 1

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  1. {#
  2. Formulaire demande de bilan
  3. Champs du formulaire
  4. #}
  6. <div class="row mb-lg-3">
  7.     <div class="col-12 col-md-6">
  8.         {{ form_row(formProspect.lastname) }}
  9.     </div>
  10.     <div class="col-12 col-md-6 mt-1 mt-md-0">
  11.         {{ form_row(formProspect.firstname) }}
  12.     </div>
  13. </div>
  14. <div class="row mb-lg-3">
  15.     <div class="col-12 col-md-6">
  16.         {{ form_row(formProspect.phoneNumber) }}
  17.     </div>
  18.     <div class="col-12 col-md-6 mt-1 mt-md-0">
  19.         {{ form_row(formProspect.email) }}
  20.     </div>
  21. </div>
  22. <div class="row mb-lg-3">
  23.     <div class="col-12 col-md-6">
  24.         {%- set type = type|default('number') -%}
  25.         {{ form_row(formProspect.yearOfBirth) }}
  26.     </div>
  27.     <div class="col-12 col-md-6 mt-1 mt-md-0">
  28.         {{ form_row(formProspect.address) }}
  29.     </div>
  30. </div>
  31. <div class="row mb-lg-3">
  32.     <div class="col-12 col-md-6">
  33.         {{ form_row(formProspect.postalcode) }}
  34.     </div>
  35.     <div class="col-12 col-md-6 mt-1 mt-md-0">
  36.         {{ form_row(formProspect.city) }}
  37.     </div>
  38. </div>
  39. <div class="row mb-lg-3">
  40.     <div class="col-12">
  41.         {{ form_label(formProspect.is_orl_prescription) }}
  42.     </div>
  43.     {% for label, value in field_choices(formProspect.is_orl_prescription) %}
  44.         <div class="col col-md-6 mb-2 mb-sm-0">
  45.             <!-- Form Radio -->
  46.             <label class="form-control" for="prospect-orl-prescription-{{ loop.index }}">
  47.             <span class="form-check">
  48.                 <input type="radio" class="form-check-input" id="prospect-orl-prescription-{{ loop.index }}"
  49.                        name="{{ field_name(formProspect.is_orl_prescription) }}" value="{{ value }}"
  50.                         {% if field_value(formProspect.is_orl_prescription) == 1 and value == 1 %} checked
  51.                         {% elseif field_value(formProspect.is_orl_prescription) == 0 and value == 0 %} checked {% endif %}
  52.                        required>
  53.                 <span class="form-check-label">{{ label }}</span>
  54.             </span>
  55.             </label>
  56.             <!-- End Form Radio -->
  57.         </div>
  58.     {% endfor %}
  59. </div>
  61. {{ form_row(formProspect.is_privacy) }}
  62. {{ form_row(formProspect.is_optin) }}
  63. {{ form_row(formProspect.submit) }}
  64. {{ form_row(formProspect.is_partner_offer) }}