{{-- resources/views/agent/leads/personal-create.blade.php --}}
@extends('layouts.contentLayoutMaster')
@section('title', 'Add Client (Personal)')

@section('content')
    <div class="card">
        <div class="card-header d-flex justify-content-between align-items-center">
            <h5 class="mb-0">Quick Add: Client</h5>
            <a href="{{ route('agent.clients') }}" class="btn btn-sm btn-outline-secondary">My Clients</a>
        </div>

        <div class="card-body">
            @if ($errors->any())
                <div class="alert alert-danger">
                    <ul class="mb-0">
                        @foreach ($errors->all() as $error)
                            <li>{{ $error }}</li>
                        @endforeach
                    </ul>
                </div>
            @endif

            <form method="POST" action="{{ route('agent.leads.personal.store') }}">
                @csrf

                <div class="row g-3">
                    <div class="col-md-6">
                        <label class="form-label">First Name *</label>
                        <input type="text" name="first_name" class="form-control" value="{{ old('first_name') }}"
                            required>
                    </div>
                    <div class="col-md-6">
                        <label class="form-label">Last Name *</label>
                        <input type="text" name="last_name" class="form-control" value="{{ old('last_name') }}" required>
                    </div>

                    <div class="col-md-6">
                        <label class="form-label">Phone *</label>
                        <input type="text" name="phone_number" class="form-control" value="{{ old('phone_number') }}"
                            required>
                    </div>
                    <div class="col-md-6">
                        <label class="form-label">Email</label>
                        <input type="email" name="email" class="form-control" value="{{ old('email') }}">
                    </div>

                    <div class="col-md-3">
                        <label class="form-label">Age</label>
                        <input type="number" name="age" class="form-control" value="{{ old('age') }}" min="0"
                            max="120">
                    </div>
                    <div class="col-md-3">
                        <label class="form-label">Date of Birth</label>
                        <input type="date" name="date_of_birth" class="form-control" value="{{ old('date_of_birth') }}">
                    </div>

                    <div class="col-md-6">
                        <label class="form-label">Address</label>
                        <input type="text" name="address" class="form-control" value="{{ old('address') }}">
                    </div>
                    <div class="col-md-4">
                        <label class="form-label">City</label>
                        <input type="text" name="city" class="form-control" value="{{ old('city') }}">
                    </div>
                    <div class="col-md-4">
                        <label class="form-label">State</label>
                        <input type="text" name="state" class="form-control" value="{{ old('state') }}">
                    </div>
                    <div class="col-md-4">
                        <label class="form-label">Zipcode</label>
                        <input type="text" name="zipcode" class="form-control" value="{{ old('zipcode') }}">
                    </div>
                    <div class="col-md-4">
                        <label class="form-label">County</label>
                        <input type="text" name="county" class="form-control" value="{{ old('county') }}">
                    </div>

                    <div class="col-md-6">
                        <label class="form-label">Insurance Type (optional)</label>
                        <input type="text" name="insurance_type" class="form-control"
                            placeholder="e.g., Term Life, Mortgage Protection" value="{{ old('insurance_type') }}">
                    </div>
                </div>

                <div class="mt-4 d-flex gap-2">
                    <button type="submit" class="btn btn-primary">Save Client</button>
                    <a href="{{ route('agent.clients') }}" class="btn btn-outline-secondary">Cancel</a>
                </div>
            </form>
        </div>
    </div>
@endsection