{{-- resources/views/agent/leads/personal-create.blade.php --}}
@extends('layouts.contentLayoutMaster')

@section('title', 'Add Personal Lead')

@section('content')
    <div class="container py-4">
        <div class="d-flex justify-content-between align-items-center mb-3">
            <h2 class="mb-0">Add Personal Lead</h2>
            <a href="{{ route('agent.leads.index') }}" class="btn btn-outline-secondary">Back to Leads</a>
        </div>

        @if (session('success'))
            <div class="alert alert-success">{{ session('success') }}</div>
        @endif

        @if ($errors->any())
            <div class="alert alert-danger">
                <strong>There were some problems with your input:</strong>
                <ul class="mb-0 mt-2">
                    @foreach ($errors->all() as $err)
                        <li>{{ $err }}</li>
                    @endforeach
                </ul>
            </div>
        @endif

        <form action="{{ route('agent.leads.personal.store') }}" method="POST" class="card p-3">
            @csrf

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

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

                {{-- Demographics --}}
                <div class="col-md-3">
                    <label class="form-label">Age</label>
                    <input type="number" name="age" value="{{ old('age') }}" class="form-control" 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" value="{{ old('date_of_birth') }}" class="form-control">
                </div>

                {{-- Address --}}
                <div class="col-md-12">
                    <label class="form-label">Address</label>
                    <input type="text" name="address" value="{{ old('address') }}" class="form-control">
                </div>
                <div class="col-md-4">
                    <label class="form-label">City</label>
                    <input type="text" name="city" value="{{ old('city') }}" class="form-control">
                </div>
                <div class="col-md-4">
                    <label class="form-label">State</label>
                    <input type="text" name="state" value="{{ old('state') }}" class="form-control">
                </div>
                <div class="col-md-4">
                    <label class="form-label">Zipcode</label>
                    <input type="text" name="zipcode" value="{{ old('zipcode') }}" class="form-control">
                </div>
                <div class="col-md-6">
                    <label class="form-label">County</label>
                    <input type="text" name="county" value="{{ old('county') }}" class="form-control">
                </div>

                {{-- Type & Status --}}
                <div class="col-md-6">
                    <label class="form-label">Insurance Type</label>
                    <select name="insurance_type" class="form-select">
                        <option value="" {{ old('insurance_type') == '' ? 'selected' : '' }}>Select</option>
                        <option value="Life" {{ old('insurance_type') == 'Life' ? 'selected' : '' }}>Life</option>
                        <option value="Mortgage Protection"
                            {{ old('insurance_type') == 'Mortgage Protection' ? 'selected' : '' }}>Mortgage Protection
                        </option>
                        <option value="Other" {{ old('insurance_type') == 'Other' ? 'selected' : '' }}>Other</option>
                    </select>
                </div>

                <div class="col-md-6">
                    <label class="form-label">Status <span class="text-danger">*</span></label>
                    <select name="status" class="form-select" required>
                        @php $st = old('status', 'New'); @endphp
                        <option value="New" {{ $st == 'New' ? 'selected' : '' }}>New</option>
                        <option value="Contacted" {{ $st == 'Contacted' ? 'selected' : '' }}>Contacted</option>
                        <option value="Qualified" {{ $st == 'Qualified' ? 'selected' : '' }}>Qualified</option>
                        <option value="Closed" {{ $st == 'Closed' ? 'selected' : '' }}>Closed</option>
                        <option value="Unresponsive" {{ $st == 'Unresponsive' ? 'selected' : '' }}>Unresponsive</option>
                    </select>
                </div>
            </div>

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