fixing health form validation
This commit is contained in:
Chris Cochrun
parent
ff2d64dd48
commit
966a6ddb67
2 changed files with 159 additions and 151 deletions
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@ -11,14 +11,64 @@
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const age = calculate_age(birthdate);
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data.append("age", age);
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if (data.get("tetanus-shot") === "") {
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console.warn("NO DATE FOR TETANUS SHOT");
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data.set("tetanus-shot", "0000-00-00");
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console.log(data.get("tetanus-shot"));
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}
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if (document.getElementById("medical-coverage").checked && data.get("insurance-name") == "") {
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document.getElementById('warning-insurance').style.visibility = 'visible';
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document.getElementById('warning-insurance').style.height = '';
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document.getElementById('warning-insurance').style.margin = '';
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return false;
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} else {
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document.getElementById('warning-insurance').style.visibility = 'hidden';
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document.getElementById('warning-insurance').style.height = '0';
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document.getElementById('warning-insurance').style.margin = '0';
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}
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if (document.getElementById("medical-coverage").checked && data.get("policy-number") == "") {
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document.getElementById('warning-policy').style.visibility = 'visible';
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document.getElementById('warning-policy').style.height = '';
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document.getElementById('warning-policy').style.margin = '';
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return false;
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} else {
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document.getElementById('warning-policy').style.visibility = 'hidden';
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document.getElementById('warning-policy').style.height = '0';
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document.getElementById('warning-policy').style.margin = '0';
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}
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if (document.getElementById("medical-coverage").checked && document.getElementById("image").files.length === 0) {
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document.getElementById('warning-image').style.visibility = 'visible';
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document.getElementById('warning-image').style.height = '';
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document.getElementById('warning-image').style.margin = '';
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return false;
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} else {
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console.warn(document.getElementById("image"));
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document.getElementById('warning-image').style.visibility = 'hidden';
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document.getElementById('warning-image').style.height = '0';
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document.getElementById('warning-image').style.margin = '0';
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}
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var xhr = new XMLHttpRequest();
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xhr.onreadystatechange = (e) => {
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if (xhr.readyState !== 4) {
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return;
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}
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if (xhr.status === 200) {
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console.log('SUCCESS', xhr.responseText);
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} else {
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console.warn('request_error', xhr.responseText);
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}
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};
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xhr.open("POST", "https://n8n.tfcconnection.org/webhook/health-form");
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xhr.send(data);
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console.log(data);
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console.log("Hallo!");
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window.location.href = "https://tfcconnection.org/thankyou/";
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window.location.replace("https://tfcconnection.org/thankyou/");
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return false;
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/* window.location.href = "/thankyou/"; */
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/* window.location.replace("https://tfcconnection.org/thankyou/"); */
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}
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function calculate_age(dob) {
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@ -41,9 +91,21 @@
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console.log(document.getElementById('policy'))
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console.log("NEGATORY");
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}
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document.getElementById('warning').style.visibility = 'hidden';
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document.getElementById('warning-insurance').style.visibility = 'hidden';
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document.getElementById('warning-policy').style.visibility = 'hidden';
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document.getElementById('warning-image').style.visibility = 'hidden';
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document.getElementById('warning').style.height = '0';
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document.getElementById('warning-insurance').style.height = '0';
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document.getElementById('warning-policy').style.height = '0';
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document.getElementById('warning-image').style.height = '0';
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document.getElementById('warning').style.margin = '0';
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document.getElementById('warning-insurance').style.margin = '0';
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document.getElementById('warning-policy').style.margin = '0';
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document.getElementById('warning-image').style.margin = '0';
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}
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document.addEventListener('DOMContentLoaded', process);
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document.addEventListener('DOMContentLoaded', process);
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function dated() {
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function nth(d) {
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@ -78,26 +140,26 @@
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<div class="basis-full flex flex-wrap my-4">
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<label for="firstname" class="basis-full">What is your first and last name?</label>
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<br/>
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<input type="text" id="firstname" name="firstname"
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<input type="text" id="firstname" name="firstname" required
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placeholder="First Name" class="flex-1 form-input {{ $formClasses }}">
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<input type="text" id="lastname" name="lastname"
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<input type="text" id="lastname" name="lastname" required
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placeholder="Last Name" class="flex-1 form-input {{ $formClasses }}">
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</div>
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<div class="basis-full my-8">
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<div class="">
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<label for="birthdate" class="">When were you born?</label>
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<input type="date" id="birthdate" name="birthdate"
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class="form-date {{ $formClasses }}">
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class="form-date {{ $formClasses }}" required>
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</div>
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</div>
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<div class="basis-full flex flex-wrap my-4">
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<label for="parentfirstname" class="basis-full">What is your parent's first and last name?</label>
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<input type="text" id="parentfirstname" name="parentfirstname"
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class="flex-1 form-input {{ $formClasses }}"
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placeholder="First Name">
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placeholder="First Name" required>
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<input type="text" id="parentlastname" name="parentlastname"
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class="flex-1 form-input {{ $formClasses }}"
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placeholder="Last Name">
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placeholder="Last Name" required>
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</div>
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<div class="basis-full flex flex-wrap my-4">
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<label for="street" class="basis-full">What is your address?</label>
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@ -116,7 +178,7 @@
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</div>
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<div class="basis-full flex flex-wrap items-center my-8">
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<div class="flex-auto flex flex-wrap items-center">
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<label for="cellphone" class="mr-4">Cell phone</label>
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<label for="cellphone" class="mr-4">Parent Cell phone</label>
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<input type="tel" id="cellphone" name="cellphone"
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pattern="[0-9]{3}-[0-9]{3}-[0-9]{4}"
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class="flex-auto form-input {{ $formClasses }}">
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@ -332,5 +394,34 @@
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<div class="basis-full mt-8">
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<button type="submit" class="content-right rounded-lg bg-primary-700 h-12 w-24 focus:bg-primary-900 focus:ring focus:ring-primary-700 hover:bg-primary-900 float-right">Submit</button>
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</div>
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<div id="warning" class="basis-full mt-10 flex px-4 py-3 rounded-lg bg-[#ef4444] dark:bg-[#ef4444]">
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<span class="text-[#fca5a5] ltr:pr-3 rtl:pl-3 content-right float-right">
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{{ partial "icon.html" (.Get 0 | default "triangle-exclamation") }}
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Make sure you have uploaded a copy of your insurance card.
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</span>
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</div>
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<div id="warning-insurance" class="basis-full mt-10 flex px-4 py-3 rounded-lg bg-[#ef4444] dark:bg-[#ef4444]">
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<span class="text-[#fca5a5] ltr:pr-3 rtl:pl-3 content-right float-right">
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{{ partial "icon.html" (.Get 0 | default "triangle-exclamation") }}
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You have not entered in your insurance name.
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</span>
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</div>
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<div id="warning-policy" class="basis-full mt-10 flex px-4 py-3 rounded-lg bg-[#ef4444] dark:bg-[#ef4444]">
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<span class="text-[#fca5a5] ltr:pr-3 rtl:pl-3 content-right float-right">
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{{ partial "icon.html" (.Get 0 | default "triangle-exclamation") }}
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You have not entered in a policy number.
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</span>
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</div>
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<div id="warning-image" class="basis-full mt-10 flex px-4 py-3 rounded-lg bg-[#ef4444] dark:bg-[#ef4444]">
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<span class="text-[#fca5a5] ltr:pr-3 rtl:pl-3 content-right float-right">
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{{ partial "icon.html" (.Get 0 | default "triangle-exclamation") }}
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You have not included a copy of your insurance card.
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</span>
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</div>
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</form>
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</div>
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