@extends('V2.layouts.onBoarding')

@section('content')
    <div class="content_wrapper">
        <div class="inner_title">
            <h3>आप फिलहाल सिगरेट से जुड़ी किन स्वास्थ्य समस्याओं का सामना कर रहे हैं?<span>*</span></h3>
            <p>सभी लागू विकल्प चुनें:</p>
            <span class="error_msg"></span>
        </div>
        <form id="frmBasic" name="frmBasic">
            <div class="wrap">
                <div class="form_field">
                    <input class="checkbox" type="checkbox" name="setHealthIssues[]" id="tiredness" value="Tiredness"
                        @checked(in_array('Tiredness', $setHealthIssues))>
                    <label class="checkbox_btn" for="tiredness">
                        थकान
                    </label>
                </div>

                <div class="form_field">
                    <input class="checkbox" type="checkbox" name="setHealthIssues[]" id="shortnessofbreath"
                        value="Shortness of breath" @checked(in_array('Shortness of breath', $setHealthIssues))>
                    <label class="checkbox_btn" for="shortnessofbreath">
                        सांस फूलना
                    </label>
                </div>

                <div class="form_field">
                    <input class="checkbox" type="checkbox" name="setHealthIssues[]" id="frequentcough"
                        value="Frequent cough/cold/flu" @checked(in_array('Frequent cough/cold/flu', $setHealthIssues))>
                    <label class="checkbox_btn" for="frequentcough">
                        बार-बार खांसी/जुकाम/फ्लू
                    </label>
                </div>

                <div class="form_field">
                    <input class="checkbox" type="checkbox" name="setHealthIssues[]" id="dentalissues" value="Dental issues"
                        @checked(in_array('Dental issues', $setHealthIssues))>
                    <label class="checkbox_btn" for="dentalissues">
                        डेंटल समस्याएं
                    </label>
                </div>

                <div class="form_field">
                    <input class="checkbox" type="checkbox" name="setHealthIssues[]" id="moodissues" value="Mood issues"
                        @checked(in_array('Mood issues', $setHealthIssues))>
                    <label class="checkbox_btn" for="moodissues">
                        मूड से जुड़ी समस्याएं
                    </label>
                </div>

                <div class="form_field">
                    <input class="checkbox" type="checkbox" name="setHealthIssues[]" id="bloodpressure"
                        value="High blood pressure" @checked(in_array('High blood pressure', $setHealthIssues))>
                    <label class="checkbox_btn" for="bloodpressure">
                        हाई ब्लड प्रेशर
                    </label>
                </div>

                <div class="form_field">
                    <input class="checkbox" type="checkbox" name="setHealthIssues[]" id="asthma" value="Asthma/COPD"
                        @checked(in_array('Asthma/COPD', $setHealthIssues))>
                    <label class="checkbox_btn" for="asthma">
                        अस्थमा/COPD
                    </label>
                </div>

                <div class="form_field">
                    <input class="checkbox" type="checkbox" name="setHealthIssues[]" id="sexualhealth"
                        value="Sexual health/impotence/fertility" @checked(in_array('Sexual health/impotence/fertility', $setHealthIssues))>
                    <label class="checkbox_btn" for="sexualhealth">
                        यौन स्वास्थ्य/नपुंसकता/प्रजनन क्षमता
                    </label>
                </div>

                <div class="form_field">
                    <input class="checkbox" type="checkbox" name="setHealthIssues[]" id="heartdisease" value="Heart disease"
                        @checked(in_array('Heart disease', $setHealthIssues))>
                    <label class="checkbox_btn" for="heartdisease">
                        हृदय रोग
                    </label>
                </div>

                <div class="form_field">
                    <input class="checkbox" type="checkbox" name="setHealthIssues[]" id="cancer" value="Cancer"
                        @checked(in_array('Cancer', $setHealthIssues))>
                    <label class="checkbox_btn" for="cancer">
                        कैंसर
                    </label>
                </div>

                <div class="form_field">
                    <input class="checkbox" type="checkbox" name="setHealthIssues[]" id="other" value="Other"
                        @checked(in_array('Other', $setHealthIssues))>
                    <label class="checkbox_btn" for="other">
                        अन्य
                    </label>
                </div>

                <div class="form_field">
                    <input class="checkbox" type="checkbox" name="setHealthIssues[]" id="nohealthissue"
                        value="No health issues" @checked(in_array('No health issues', $setHealthIssues))>
                    <label class="checkbox_btn" for="nohealthissue">
                        कोई स्वास्थ्य समस्या नहीं
                    </label>
                </div>
            </div>
            <div class="form_field button_wrap">
                <button type="button" class="button" name="btnSubmit" id="btnSubmit">सब्मिट</button>
            </div>
        </form>
    </div>
@endsection