{% extends 'base.html.twig' %} {% block title %}Edit Referral Source {% endblock %} {% block body %} {{ block('nav', 'internal/libs/nav.html.twig') }} <main class="main-content position-relative max-height-vh-100 h-100 border-radius-lg "> {{ block('topnav', 'internal/libs/top-nav.html.twig') }} <section> <div class='page-header min-vh-100'> <div class='container'> <div class="row"> <div class="col-6 d-lg-flex d-none h-100 my-auto pe-0 position-absolute top-0 start-0 text-center justify-content-center flex-column"> <div class="position-relative bg-gradient-primary h-100 m-3 px-7 border-radius-lg d-flex flex-column justify-content-center" style="background-image: url('/assets/img/illustrations/illustration-signup.jpg'); background-size: cover;"></div> </div> <div class="col-xl-4 col-lg-5 col-md-7 d-flex flex-column ms-auto me-auto ms-lg-auto me-lg-5"> <div class="card card-plain"> <div class="card-header"> <h4 class="font-weight-bolder">Edit Referral Source</h4> <p class="mb-0">{{ rs.name }}</p> </div> <div class="card-body"> {{ form_errors(form) }} {{ form_start(form) }} <div class='input-group input-group-outline mb-3 is-filled'> <label for='ref_src_name' class='form-label'>Name</label> <input type='text' name='{{ field_name(form.name) }}' value='{{ field_value(form.name) }}' id='ref_src_name' class='form-control' required='required'/> </div> <div class='input-group input-group-outline mb-3 is-filled'> <label for='ref_src_agency' class='form-label'>Agency</label> <input type='text' name='{{ field_name(form.agency) }}' value='{{ field_value(form.agency) }}' id='ref_src_agency' class='form-control' required='required'/> </div> <div class='input-group input-group-outline mb-3 is-filled'> <label for='ref_src_email' class='form-label'>Email</label> <input type='email' name='{{ field_name(form.email) }}' value='{{ field_value(form.email) }}' id='ref_src_email' class='form-control' required='required'/> </div> <div class='input-group input-group-outline mb-3 {% if field_value(form.phone) %}is-filled{% endif %}'> <label for='ref_src_phone' class='form-label'>Phone</label> <input type='phone' name='{{ field_name(form.phone) }}' value='{{ field_value(form.phone) }}' id='ref_src_phone' class='form-control'/> </div> <div class='input-group input-group-outline mb-3 is-filled'> <label for='ref_src_county' class='form-label'>County</label> <input type='text' name='{{ field_name(form.county) }}' value='{{ field_value(form.county) }}' id='ref_src_county' class='form-control'/> </div> <div class='text-center'> <button type='submit' class='btn btn-lg bg-gradient-dark btn-lg w-100 mt-4 mb-0'>Save Source</button> </div> {{ form_end(form) }} </div> </div> </div> </div> </div> </section> </main> {% endblock %}