bhl-forms 0.0.38 → 0.0.39
This diff represents the content of publicly available package versions that have been released to one of the supported registries. The information contained in this diff is provided for informational purposes only and reflects changes between package versions as they appear in their respective public registries.
- package/dist/bhl-forms.es.js +14 -9
- package/dist/bhl-forms.iife.js +4 -4
- package/dist/bhl-forms.modern.es.js +14 -9
- package/dist/bhl-forms.modern.iife.js +7 -7
- package/dist/bhl-forms.modern.umd.js +7 -7
- package/dist/bhl-forms.umd.js +4 -4
- package/dist/forms/childAndFamily.es.js +125 -79
- package/dist/forms/childAndFamily.iife.js +1 -1
- package/dist/forms/childAndFamily.json +1 -1
- package/dist/forms/generalLegal.es.js +2449 -0
- package/dist/forms/generalLegal.iife.js +1 -0
- package/dist/forms/generalLegal.json +1 -0
- package/dist/forms/testForm.es.js +11 -17
- package/dist/forms/testForm.iife.js +1 -1
- package/dist/forms/testForm.json +1 -1
- package/dist/main.css +1 -1
- package/package.json +1 -1
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var generalLegal=function(){"use strict";function e(){return Object.assign({},...arguments)}function a(e){return"https://justanswer.9pctbx.net/c/2880795/"+e+"/9320?sharedid=${properties.vid}"}const t={type:"form",id:"form",onSubmit:'$submit("https://httpbin.org/post", $prepData, $getRedirect)',plugins:"$plugins",actions:!1,prepop:{fromURL:!0},errorCodes:{403:"An Error Occurred",409:{abort:!1},429:"An Error Occurred"},formClass:"!t-max-w-[38rem]"};const i={type:"meta",data:{tcpaLanguage:"By checking this box, I a) agree to the Terms of Use, and b) consent to be contacted by lawyers, lawyer networks, and partners of this website using live, autodialed, pre-recorded, or artificial voice calls, as well as text messages. Your consent is not required as a condition of purchasing any goods or services. To submit this request without this consent, call 855-506-0847."}};const n={$el:"div",children:[{$el:"div",attrs:{id:"form-anchor",class:"t-absolute",style:{top:"-20px",left:0}}}],attrs:{class:"t-relative"}};const r={$el:"h1",if:"$activeStep === $firstStep()",attrs:{class:"t-flex t-justify-center t-text-center t-text-3xl t-font-semibold t-pt-5 t-px-3"}};const o={$el:"h3",if:"$activeStep === $firstStep()",attrs:{class:"t-flex t-justify-center t-text-center t-text-md t-font-medium t-text-blue-500 t-px-10"}};const s={Adoption:a("565949"),Bankruptcy:a("1147978"),"Child Custody and Support":a("565949"),"Civil Lawsuit":a("897042"),"Consumer Lawyers":a("897042"),"Criminal and Felony":a("897012"),"Debt and Collections":a("1147978"),"Divorce and Separation":a("966410"),"DUI and DWI":a("897012"),"Elder Law":a("565949"),"Employment and Workplace":a("897014"),Expungement:a("897012"),Foreclosure:a("565923"),Guardianship:a("565949"),"Landlord and Tenant":a("1315025"),"Power of Attorney":a("1097602"),"Probate and Estates":a("1097602"),"Product Liability":a("897042"),"Property Damage":a("897042"),"Real Estate":a("565923"),"Social Security Disability and Insurance":a("897033"),"Tax and IRS":a("1147978"),"Traffic and Tickets":a("808601"),Unemployment:a("897014"),"Victim of a Crime":a("897012"),"Wills and Trusts":a("1097602"),"Workers Compensation":a("897014"),"Wrongful Termination":a("897014"),"*":a("808601")};const l=a=>e({$formkit:"checkbox",validation:"required",validationMessages:{required:"Field is required"}},a),d=a=>e({$formkit:"radio",validation:"required",validationMessages:{required:"Field is required"},optionsClass:"t-pt-3 t-pl-1",legendClass:"required"},a),u=e=>(e.legendClass="legend-left required",e.fieldsetClass="$reset side-by-side",e.optionsClass="t-pl-1",e.innerClass="t-flex t-items-center",e.wrapperClass="t-mb-3",d(e)),m=e=>(e.legendClass="legend-left-flex md:t-max-w-[40%] required",e.fieldsetClass="$reset side-by-side-flex",e.optionsClass="md:t-ml-4 t-grid t-grid-cols-1 md:t-grid-cols-2-125",e.innerClass="t-flex t-items-start",e.wrapperClass="$reset t-flex t-cursor-pointer t-mb-3",d(e)),c=e=>(e.legendClass="legend-left t-pb-1 required",e.fieldsetClass="$reset side-by-side t-items-center",e.optionsClass="t-mt-1 t-grid t-grid-cols-1 md:t-grid-cols-2-125 t-items-center",e.innerClass="t-flex t-items-center",d(e)),p=e=>(e.options=["Yes","No"],c(e)),h=a=>(a.labelClass="required",a.wrapperClass="side-by-side t-items-center",a.innerClass="select-height-content",(a=>e({$formkit:"select",placeholder:"Please Select",validation:"required",validationMessages:{required:"Field is required"},inputClass:"t-bg-white",labelClass:"required"},a))(a)),y=a=>(a.wrapperClass="side-by-side t-items-center",(a=>e({$formkit:"text",validation:"required",validationMessages:{required:"Field is required"},labelClass:"required"},a))(a)),g=a=>(a.wrapperClass="side-by-side t-items-center",(a=>e({$formkit:"date",validation:"required",validationMessages:{required:"Field is required"},labelClass:"required"},a))(a)),f=()=>h({label:"Age of Applicant?",name:"Applicant_Age",options:["18","19","20","21","22","23","24","25","26","27","28","29","30","31","32","33","34","35","36","37","38","39","40","41","42","43","44","45","46","47","48","49","50","51","52","53","54","55","56","57","58","59","60","61","62","63","64","65"]}),b=()=>p({name:"At_Fault",label:"Were You at Fault?"}),_=()=>h({label:"Status of Claim:",name:"Claim_Status",options:["No action taken yet","Demand for compensation made","Lawsuit filed","Other"]}),v=()=>g({label:"When was the Alleged Crime Committed?",name:"Crime_Committed_Date"}),C=e=>h({label:"How Likely Are You to Pay if Your Issue Could be Resolved?",name:"Degree_Of_Interest",help:e,options:["Definitely","Probably","Maybe","Absolutely Can't Afford"]}),$=()=>C("No payment necessary to speak with lawyers."),T=()=>p({name:"Doctor_Treatment",label:"Have You Recently Been Treated by a Doctor, Hospital or Clinic?"}),P=()=>y({$formkit:"email",name:"Email",label:"Email Address:",placeholder:"email@domain.com",validation:"required|email",validationMessages:{required:"Email is required",email:"Invalid Email"}}),L=()=>h({label:"The Employer Is a:",name:"Employer_Type",options:["Sole proprietorship (mom and pop)","Partnership","Franchise","Privately held company","Public corporation","Government Agency","Don't know"]}),A=()=>h({label:"Legal Services Needed for Your Estate:",name:"Estate_Legal_Services_Needed",options:["Charitable Giving","Contested Wills","Drafting Wills or Trust","Estate Administration","Asset Protection","Other"]}),S=()=>y({$formkit:"text",label:"First Name:",name:"First_Name",validationMessages:{required:"First Name is required"}}),D=()=>h({label:"Type of Help Needed:",name:"Type_Of_Legal_Problem",id:"Type_Of_Legal_Problem",options:["Adoption","Asbestos and Mesothelioma","Auto and Car Accidents","Bankruptcy","Birth Certificate and Name Change","Business Lawyers","Child Custody and Support","Civil Rights and Discrimination","Civil Lawsuit","Consumer Lawyers","Copyrights and Trademarks","Criminal and Felony","Debt and Collections","Divorce and Separation","DUI and DWI","Elder Law","Employment and Workplace","Expungement","Family Issues","Foreclosure","Guardianship","Harassment and Discrimination","Identity Theft","Immigration and Visas","Insurance","Landlord and Tenant","Lemon Law","Long Term Disability","Medical Malpractice","Nursing Home Abuse","Patents and Intellectual Property","Personal Injury","Power of Attorney","Probate and Estates","Product Liability","Property Damage","Real Estate","Social Security Disability and Insurance","Tax and IRS","Traffic and Tickets","Unemployment","Vaccination Injury","Veteran's Disability","Victim of a Crime","Wills and Trusts","Workers Compensation","Wrongful Death","Wrongful Termination","Not Sure or Other"]}),I=()=>p({name:"Have_Attorney",label:"Are You Currently Working with An Attorney?"}),O=()=>p({name:"Have_Children",label:"Do You Have Children?"}),w=()=>g({label:"Date of Incident:",name:"Incident_Date"}),x=()=>y({$formkit:"text",label:"Last Name:",name:"Last_Name",validationMessages:{required:"Last Name is required"}}),k=()=>h({label:"The Other Party is a:",name:"Lawsuit_Other_Party",options:["Individual","Small Business","Large Corporation","Government Entity"]}),M=()=>h({label:"How Will You Pay for Legal Fees if You Hire a Lawyer?",name:"Lawyer_Payment_Method",help:"No payment necessary to speak with lawyers.",options:["Cash","Check","Credit Card","Friend","Family","Other"]}),B=()=>h({label:"Marital Status:",name:"Marital_Status",options:["Unmarried, Living Together","Unmarried, Do Not Live Together","Married, Living Together","Separated","Divorced","Other"]}),R=()=>h({label:"Total Employees of Business? (estimated)",name:"Num_Employees_Of_Business",options:["1-5","6-20","21-50","51-100","101-500","501-1,000","More than 1,000"]}),N=()=>p({name:"Own_Real_Estate",label:"Do You Own Real Estate?"}),W=()=>p({name:"Pending_Charges",label:"Do you currently have any pending charges?"}),E=()=>y({$formkit:"tel",name:"Primary_Phone",label:"Phone Number:",placeholder:"xxx-xxx-xxxx",maxlength:12,validation:"required|matches:/^[0-9]{3}-?[0-9]{3}-?[0-9]{4}$/",validationMessages:{required:"Phone Number is required",matches:"Invalid Phone Number"}}),Q=()=>m({label:"Primary Injury:",name:"Primary_Injury",options:["Anxiety","Back or Neck Pain","Broken Bones","Cuts and Bruises","Headaches","Memory Loss","Loss of Limb","Other (describe on next page)"]}),q=()=>h({label:"Area of Real Estate:",name:"Real_Estate_Area",options:["Condos and Coops","Construction Disputes","Purchase/Sale Contract","Refinancing Agreement","Title and Boundary Disputes","Zoning, Planning and Land Use","Property Deeds and Transfers","Liens","Other"]}),F=()=>u({label:"What is Your Role in this Matter?",name:"Role_In_Matter_Criminal",options:["I have been accused","I am acting on behalf of someone who has been accused","Other"]}),K=()=>h({label:"What Is Your Role in this Matter?",name:"Role_In_Matter_Probate",options:["Preparing My Will","Executor","Heir","Other"]}),H=()=>h({label:"Total Debt?",name:"Total_Debt",options:["Less than 5K","5K to 10K","10K to 20K","20K to 50K","More than 50K"]}),V=()=>h({label:"Total Monthly Income?",name:"Total_Monthly_Income",options:["Less than 1K","1K to 2K","2K to 3K","3K to 4K","4K to 5K","5K to 7K","7K to 10K","10K to 15K","More than 15K"]}),Y=()=>{return(e={label:"Type of Assets:",name:"Type_Of_Assets",options:["Business Interests","Cash","Life Insurance Policies","Pensions/Retirement","Personal Possessions","Property","Stock/Bonds"]}).legendClass="required",e.fieldsetClass="$reset",e.optionsClass="t-pl-2 t-pt-3 t-grid t-grid-cols-1 md:t-grid-cols-2",e.innerClass="t-items-start",e.wrapperClass="$reset t-flex t-cursor-pointer t-mb-3",l(e);var e},j=()=>h({label:"Value of Your Assets?",name:"Value_Of_Assets",options:["Less than 50K","50K to 100K","100K to 250K","250K to 500K","500K to 1M","More than 1M"]}),U=()=>{return(e={label:"What Service Connected Conditions Does the Applicant Have? (select all that apply)",name:"Veterans_Disability_Conditions",options:["Traumatic Physical Injury (broken bones, loss of limb)","Mental Injury","Occupational Disease","Repeated Trauma Injury","Other"]}).legendClass="legend-left required",e.fieldsetClass="$reset side-by-side",e.optionsClass="t-pl-1",e.innerClass="t-flex t-items-center",e.wrapperClass="t-mb-3",l(e);var e},G=()=>u({label:"I Would Like a Lawyer to:",name:"Would_Like_Lawyer_To",options:["Give me general advice to protect my interests","Act as my agent in the transaction","Assist me in the remaining stages of the transaction","Bring a lawsuit against another party","Defend against a lawsuit filed by another party","Other"]}),z=()=>y({label:"Zip Code:",placeholder:"90210",name:"Zip",maxlength:5,inputmode:"numeric",validation:"required|matches:/^[0-9]{5}$/",validationMessages:{required:"Zip Code is required",matches:"Invalid Zip Code"}}),Z=(a,t)=>e({$cmp:"FormKit",props:{type:"group",key:a,id:a,name:a}},t),J=()=>Z("AdoptionQuestions",{if:'$get(Type_Of_Legal_Problem).value == "Adoption"',children:[I(),B(),O(),C(),M()]}),X=()=>Z("AsbestosAndMesotheliomaQuestions",{if:'$get(Type_Of_Legal_Problem).value == "Asbestos and Mesothelioma"',children:[w(),T()]}),ee=()=>Z("AutoAndCarAccidentsQuestions",{if:'$get(Type_Of_Legal_Problem).value == "Auto and Car Accidents"',children:[I(),w(),b(),Q(),T(),p({name:"Police_Report_Filed",label:"Was a Police Report Filed?"})]}),ae=()=>Z("BankruptcyQuestions",{if:'$get(Type_Of_Legal_Problem).value == "Bankruptcy"',children:[I(),V(),H(),N(),j(),$()]}),te=()=>Z("BirthCertificateAndNameChangeQuestions",{if:'$get(Type_Of_Legal_Problem).value == "Birth Certificate and Name Change"',children:[I(),$()]}),ie=()=>Z("BusinessLawyersQuestions",{if:'$get(Type_Of_Legal_Problem).value == "Business Lawyers"',children:[I(),h({label:"Legal Services Needed for Your Business:",name:"Business_Services",options:["Business Formation","Contracts","Insurance and Liability","Mergers and Acquisition","Regulatory Compliance","Employee Dispute","Other"]}),m({label:"Is the Business Public or Private?",name:"Business_Type",options:["Public","Private"]}),R(),$()]}),ne=()=>Z("ChildCustodyAndSupportQuestions",{if:'$get(Type_Of_Legal_Problem).value == "Child Custody and Support"',children:[I(),h({label:"Your Relationship to Child(ren):",name:"Child_Relationship",options:["Father","Mother","Grandparent","Aunt/Uncle","Other"]}),h({label:"With Whom Do the Children Currently Live?",name:"Child_Home",options:["Mother","Father","Grandparents","Other"]}),h({label:"Who is the Primary Caregiver?",name:"Child_Primary_Caregiver",options:["Mother","Father","Other"]}),C(),M()]}),re=()=>Z("CivilRightsAndDiscriminationQuestions",{if:'$get(Type_Of_Legal_Problem).value == "Civil Rights and Discrimination"',children:[I(),$()]}),oe=()=>Z("CivilLawsuitQuestions",{if:'$get(Type_Of_Legal_Problem).value == "Civil Lawsuit"',children:[I(),w(),k(),$()]}),se=()=>Z("ConsumerLawyersQuestions",{if:'$get(Type_Of_Legal_Problem).value == "Consumer Lawyers"',children:[I(),w(),k(),$()]}),le=()=>Z("CopyrightsAndTrademarksQuestions",{if:'$get(Type_Of_Legal_Problem).value == "Copyrights and Trademarks"',children:[I(),$()]}),de=()=>Z("CriminalAndFelonyQuestions",{if:'$get(Type_Of_Legal_Problem).value == "Criminal and Felony"',children:[I(),v(),F(),W(),C(),M()]}),ue=()=>Z("DebtAndCollectionsQuestions",{if:'$get(Type_Of_Legal_Problem).value == "Debt and Collections"',children:[I(),V(),H(),N(),j(),$()]}),me=()=>Z("DivorceQuestions",{if:'$get(Type_Of_Legal_Problem).value == "Divorce and Separation"',children:[I(),B(),O(),C(),M()]}),ce=()=>Z("DUIAndDWIQuestions",{if:'$get(Type_Of_Legal_Problem).value == "DUI and DWI"',children:[I(),w(),p({name:"Prior_Alcohol_Offenses",label:"Any Prior Alcohol Related Offenses?"}),h({label:"Type of Alcohol Test Performed?",name:"Type_Of_Alcohol_Test",options:["No Test","Refused Test","Breath Test","Blood Test","Urine Test","Don't Know"]}),h({label:"Blood Alcohol Content Measured by Test:",name:"Blood_Alcohol_Content_Test",options:["No Test","0.00% - 0.04%","0.05% - 0.08%","0.09% - 0.12%","0.13% - 0.16%","0.17% - 0.20%","More than 0.20%","Don't know"]}),W(),$()]}),pe=()=>Z("ElderLawQuestions",{if:'$get(Type_Of_Legal_Problem).value == "Elder Law"',children:[I(),$()]}),he=()=>Z("EmploymentAndWorkplaceQuestions",{if:'$get(Type_Of_Legal_Problem).value == "Employment and Workplace"',children:[I(),R(),L(),C(),M()]}),ye=()=>Z("ExpungementQuestions",{if:'$get(Type_Of_Legal_Problem).value == "Expungement"',children:[I(),w(),h({label:"What Type of Charge?",name:"Criminal_Charge_Type",options:["Felony","Misdemeanor","Juvenile","Other"]}),C(),M()]}),ge=()=>Z("FamilyIssuesQuestions",{if:'$get(Type_Of_Legal_Problem).value == "Family Issues"',children:[I(),B(),O(),C(),M()]}),fe=()=>Z("ForeclosureQuestions",{if:'$get(Type_Of_Legal_Problem).value == "Foreclosure"',children:[I(),N(),h({label:"Type of Property:",name:"Type_Of_Property",options:["Residential","Commercial","Industrial","Agricultural","Recreational","Other"]}),h({label:"Total Amount of Payments that are Past Due:",name:"Amount_Payments_Past_Due",options:["$0 - $499","$500 - $999","$1,000 - $2,499","$2,500 - $4,999","$5,000 - $9,999","$10,000 - $24,999","$25,000 - $49,999","$50,000 - $99,999","More than $100,000"]}),h({label:"Total Amount of Loan?",name:"Loan_Amount",options:["Less than $10,000","$10,000 - $24,999","$25,000 - $49,999","$50,000 - $99,999","$100,000 - $199,999","$200,000 - $299,999","$300,000 - $399,999","$400,000 - $499,999","$500,000 - $599,999","More than $600,000"]}),p({name:"Default_Notice",label:"Have You Received a Notice of Default from the Lender?"})]}),be=()=>Z("GuardianshipQuestions",{if:'$get(Type_Of_Legal_Problem).value == "Guardianship"',children:[I(),B(),O(),C(),M()]}),_e=()=>Z("HarassmentAndDiscriminationQuestions",{if:'$get(Type_Of_Legal_Problem).value == "Harassment and Discrimination"',children:[I(),$()]}),ve=()=>Z("IdentityTheftQuestions",{if:'$get(Type_Of_Legal_Problem).value == "Identity Theft"',children:[I(),$()]}),Ce=()=>Z("ImmigrationAndVisasQuestions",{if:'$get(Type_Of_Legal_Problem).value == "Immigration and Visas"',children:[I(),h({label:"What is Your Current Country of Citizenship?",name:"Country_Of_Citizenship",options:["Afghanistan","Albania","Algeria","Andorra","Angola","Antigua and Barbuda","Argentina","Armenia","Australia","Austria","Azerbaijan","Bahamas","The Bahrain","Bangladesh","Barbados","Belarus","Belgium","Belize","Benin","Bhutan","Bolivia","Bosnia and Herzegovina","Botswana","Brazil","Brunei","Bulgaria","Burkina Faso","Burundi","Cambodia","Cameroon","Canada","Cape Verde","Central African Republic","Chad","Chile","China","Colombia","Comoros","Congo (Congoâ Kinshasa)","Congo (Congoâ Brazzaville)","Costa Rica","Coted'Ivoire (Ivory Coast)","Croatia","Cuba","Cyprus","Czech Republic","Denmark","Djibouti","Dominica","Dominican Republic","Ecuador","Egypt","El Salvador","Equatorial Guinea","Eritrea","Estonia","Ethiopia","Fiji","Finland","France","Gabon","Gambia","Georgia","Germany","Ghana","Greece","Grenada","Guatemala","Guinea","Guinea-Bissau","Guyana","Haiti","Honduras","Hungary","Iceland","India","Indonesia","Iran","Iraq","Ireland","Israel","Italy","Jamaica","Japan","Jordan","Kazakhstan","Kenya","Kiribati","Korea (North Korea)","Korea (South Korea)","Kuwait","Kyrgyzstan","Laos","Latvia","Lebanon","Lesotho","Liberia","Libya","Liechtenstein","Lithuania","Luxembourg","Macedonia","Madagascar","Malawi","Malaysia","Maldives","Mali","Malta","Marshall Islands","Mauritania","Mauritius","Mexico","Micronesia","Moldova","Monaco","Mongolia","Montenegro","Morocco","Mozambique","Myanmar (Burma)","Namibia","Nauru","Nepal","Netherlands","New Zealand","Nicaragua","Niger","Nigeria","Norway","Oman","Pakistan","Palau","Panama","Papua New Guinea","Paraguay","Peru","Philippines","Poland","Portugal","Qatar","Romania","Russia","Rwanda","Saint Kitts and Nevis","SaintLucia","Saint Vincent and the Grenadines","Samoa","San Marino","Sao Tome and Principe","Saudi Arabia","Senegal","Serbia","Seychelles","Sierra Leone","Singapore","Slovakia","Slovenia","Solomon Islands","Somalia","South Africa","Spain","SriLanka","Sudan","Suriname","Swaziland","Sweden","Switzerland","Syria","Tajikistan","Tanzania","Thailand","Timor-Leste (East Timor)","Togo","Tonga","Trinidad and Tobago","Tunisia","Turkey","Turkmenistan","Tuvalu","Uganda","Ukraine","United Arab Emirates","United Kingdom","United States","Uruguay","Uzbekistan","Vanuatu","Vatican City","Venezuela","Vietnam","Yemen","Zambia","Zimbabwe"]}),h({label:"Where Are You Migrating To?",name:"Immigration_Location",options:["In the USA","Outside the USA"]}),h({label:"How are you Trying to Enter the Country?",name:"Immigration_Entry",options:["With Proper Documents/Visa and Inspection through Customs Border Patrol","Illegally","No Entry","Other"]}),h({label:"What Type of Immigration Issue?",name:"Immigration_Type",options:["Citizenship (for current green card holders)","Permanent Visa Family Based (green cards)","Permanent Visa Business Based (green cards)","Temporary Business Visa","Temporary Tourist Visa","Investor","Asylum","Self Petition (violence & abuse victims)","Removal/Deportation Proceeding","Other"]}),h({label:"What is the Current Status of the Immigration Case?",name:"Immigration_Status",options:["Out of Status (overstayed my visa)","Current Visa Holder (in status)","Lawful Permanent Resident (green card)","Not Applicable (outside the USA)","Other"]}),h({label:"Where is the Person Seeking Immigration Located?",name:"Immigration_Details",options:["In the USA with proper documentation","In the USA without proper documentation","Not in the USA","In Deportation/Removal Proceedings","Currently Detained (friend or family submitting this request)","Out on Bond","None Apply"]}),$()]}),$e=()=>Z("InsuranceQuestions",{if:'$get(Type_Of_Legal_Problem).value == "Insurance"',children:[I(),$()]}),Te=()=>Z("LandlordAndTenantQuestions",{if:'$get(Type_Of_Legal_Problem).value == "Landlord and Tenant"',children:[I(),h({label:"I am the:",name:"Landlord_Tenant_Party",options:["Landlord","Tenant","Other"]}),h({label:"What is the Landlord / Tenant Issue?",name:"Landlord_Tenant_Issue",options:["Environmental Hazards","Eviction","Discrimination","Lease and Rental Agreements","Repairs and Maintenance","Right of Entry and Privacy","Screening and Applications","Other Dispute"]}),$()]}),Pe=()=>Z("LemonLawQuestions",{if:'$get(Type_Of_Legal_Problem).value == "Lemon Law"',children:[I(),w(),k(),$()]}),Le=()=>Z("LongTermDisabilityQuestions",{if:'$get(Type_Of_Legal_Problem).value == "Long Term Disability"',children:[I(),y({label:"What is the Applicant's Occupation?",name:"Applicant_Occupation",placeholder:"Occupation"}),f(),p({name:"Applicant_Lt_Disability_Policy",label:"Does Applicant have a Long Term Disability Policy?"}),h({label:"How Did Applicant Obtain the Disability Policy?",name:"Applicant_Disability_How_Obtain",options:["Employer","Self","Other"]}),u({name:"Applicant_Previously_Apply_Ltd_Benefits",label:"Has Applicant Previously Applied for Long Term Disability Benefits?",options:["Yes, claim pending","Yes, claim denied","No"]}),u({name:"Applicant_Received_Disability_Benefits",label:"Has Applicant Ever Received Long Term Disability Benefits for this Claim?",options:["Yes, currently receiving","Yes, appealing a decision to stop payment of benefits","No"]}),h({label:"Applicant's Monthly Salary/Pay When Last at Work:",name:"Applicant_Monthly_Salary",options:["< $1,000","$1,000 - $2,000","$2,000 - $3,000","$3,000 - $4,000","$4,000 - $5,000","$5,000 - $6,000","$6,000 - $7,000","$7,000 - $8,000","$8,000 - $9,000","$9,000 - 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(select all that apply)","name":"Veterans_Disability_Conditions","options":["Traumatic Physical Injury (broken bones, loss of limb)","Mental Injury","Occupational Disease","Repeated Trauma Injury","Other"],"legendClass":"legend-left required","fieldsetClass":"$reset side-by-side","optionsClass":"t-pl-1","innerClass":"t-flex t-items-center","wrapperClass":"t-mb-3"},{"$formkit":"select","placeholder":"Please Select","validation":"required","validationMessages":{"required":"Field is required"},"inputClass":"t-bg-white","labelClass":"required","label":"Has the Applicant Applied for VA Disability Compensation?","name":"Veterans_Disability_Applied","options":["Yes, Claim filed and awaiting decision","Yes, Claim denied","Yes, Claim on appeal","Yes, Claim approved","Yes, Benefits awarded","No, Claim has not been filed"],"wrapperClass":"side-by-side t-items-center","innerClass":"select-height-content"}]},{"$cmp":"FormKit","props":{"type":"group","key":"VictimOfACrimeQuestions","id":"VictimOfACrimeQuestions","name":"VictimOfACrimeQuestions"},"if":"$get(Type_Of_Legal_Problem).value == \"Victim of a Crime\"","children":[{"$formkit":"radio","validation":"required","validationMessages":{"required":"Field is required"},"optionsClass":"t-mt-1 t-grid t-grid-cols-1 md:t-grid-cols-2-125 t-items-center","legendClass":"legend-left t-pb-1 required","name":"Have_Attorney","label":"Are You Currently Working with An Attorney?","options":["Yes","No"],"fieldsetClass":"$reset side-by-side t-items-center","innerClass":"t-flex t-items-center"},{"$formkit":"date","validation":"required","validationMessages":{"required":"Field is required"},"labelClass":"required","label":"When was the Alleged Crime Committed?","name":"Crime_Committed_Date","wrapperClass":"side-by-side t-items-center"},{"$formkit":"radio","validation":"required","validationMessages":{"required":"Field is required"},"optionsClass":"t-pl-1","legendClass":"legend-left required","label":"What is Your Role in this Matter?","name":"Role_In_Matter_Criminal","options":["I have been accused","I am acting on behalf of someone who has been accused","Other"],"fieldsetClass":"$reset side-by-side","innerClass":"t-flex t-items-center","wrapperClass":"t-mb-3"},{"$formkit":"radio","validation":"required","validationMessages":{"required":"Field is required"},"optionsClass":"t-mt-1 t-grid t-grid-cols-1 md:t-grid-cols-2-125 t-items-center","legendClass":"legend-left t-pb-1 required","name":"Pending_Charges","label":"Do you currently have any pending charges?","options":["Yes","No"],"fieldsetClass":"$reset side-by-side t-items-center","innerClass":"t-flex t-items-center"},{"$formkit":"select","placeholder":"Please Select","validation":"required","validationMessages":{"required":"Field is required"},"inputClass":"t-bg-white","labelClass":"required","label":"How Likely Are You to Pay if Your Issue Could be Resolved?","name":"Degree_Of_Interest","options":["Definitely","Probably","Maybe","Absolutely Can't Afford"],"wrapperClass":"side-by-side t-items-center","innerClass":"select-height-content"},{"$formkit":"select","placeholder":"Please Select","validation":"required","validationMessages":{"required":"Field is required"},"inputClass":"t-bg-white","labelClass":"required","label":"How Will You Pay for Legal Fees if You Hire a Lawyer?","name":"Lawyer_Payment_Method","help":"No payment necessary to speak with lawyers.","options":["Cash","Check","Credit Card","Friend","Family","Other"],"wrapperClass":"side-by-side t-items-center","innerClass":"select-height-content"}]},{"$cmp":"FormKit","props":{"type":"group","key":"WillsAndTrustsQuestions","id":"WillsAndTrustsQuestions","name":"WillsAndTrustsQuestions"},"if":"$get(Type_Of_Legal_Problem).value == \"Wills and Trusts\"","children":[{"$formkit":"radio","validation":"required","validationMessages":{"required":"Field is required"},"optionsClass":"t-mt-1 t-grid t-grid-cols-1 md:t-grid-cols-2-125 t-items-center","legendClass":"legend-left t-pb-1 required","name":"Have_Attorney","label":"Are You Currently Working with An Attorney?","options":["Yes","No"],"fieldsetClass":"$reset side-by-side t-items-center","innerClass":"t-flex t-items-center"},{"$formkit":"select","placeholder":"Please Select","validation":"required","validationMessages":{"required":"Field is required"},"inputClass":"t-bg-white","labelClass":"required","label":"Value of Your Assets?","name":"Value_Of_Assets","options":["Less than 50K","50K to 100K","100K to 250K","250K to 500K","500K to 1M","More than 1M"],"wrapperClass":"side-by-side t-items-center","innerClass":"select-height-content"},{"$formkit":"checkbox","validation":"required","validationMessages":{"required":"Field is required"},"label":"Type of Assets:","name":"Type_Of_Assets","options":["Business Interests","Cash","Life Insurance Policies","Pensions/Retirement","Personal Possessions","Property","Stock/Bonds"],"legendClass":"required","fieldsetClass":"$reset","optionsClass":"t-pl-2 t-pt-3 t-grid t-grid-cols-1 md:t-grid-cols-2","innerClass":"t-items-start","wrapperClass":"$reset t-flex t-cursor-pointer t-mb-3"},{"$formkit":"select","placeholder":"Please Select","validation":"required","validationMessages":{"required":"Field is required"},"inputClass":"t-bg-white","labelClass":"required","label":"What Is Your Role in this Matter?","name":"Role_In_Matter_Probate","options":["Preparing My Will","Executor","Heir","Other"],"wrapperClass":"side-by-side t-items-center","innerClass":"select-height-content"},{"$formkit":"select","placeholder":"Please Select","validation":"required","validationMessages":{"required":"Field is required"},"inputClass":"t-bg-white","labelClass":"required","label":"Legal Services Needed for Your Estate:","name":"Estate_Legal_Services_Needed","options":["Charitable Giving","Contested Wills","Drafting Wills or Trust","Estate Administration","Asset Protection","Other"],"wrapperClass":"side-by-side t-items-center","innerClass":"select-height-content"},{"$formkit":"select","placeholder":"Please Select","validation":"required","validationMessages":{"required":"Field is required"},"inputClass":"t-bg-white","labelClass":"required","label":"How Likely Are You to Pay if Your Issue Could be Resolved?","name":"Degree_Of_Interest","help":"No payment necessary to speak with lawyers.","options":["Definitely","Probably","Maybe","Absolutely Can't Afford"],"wrapperClass":"side-by-side t-items-center","innerClass":"select-height-content"}]},{"$cmp":"FormKit","props":{"type":"group","key":"WorkersCompensationQuestions","id":"WorkersCompensationQuestions","name":"WorkersCompensationQuestions"},"if":"$get(Type_Of_Legal_Problem).value == \"Workers Compensation\"","children":[{"$formkit":"radio","validation":"required","validationMessages":{"required":"Field is required"},"optionsClass":"t-mt-1 t-grid t-grid-cols-1 md:t-grid-cols-2-125 t-items-center","legendClass":"legend-left t-pb-1 required","name":"Have_Attorney","label":"Are You Currently Working with An Attorney?","options":["Yes","No"],"fieldsetClass":"$reset side-by-side t-items-center","innerClass":"t-flex t-items-center"},{"$formkit":"date","validation":"required","validationMessages":{"required":"Field is required"},"labelClass":"required","label":"Date of Incident:","name":"Incident_Date","wrapperClass":"side-by-side t-items-center"},{"$formkit":"select","placeholder":"Please Select","validation":"required","validationMessages":{"required":"Field is required"},"inputClass":"t-bg-white","labelClass":"required","label":"Status of Claim:","name":"Claim_Status","options":["No action taken yet","Demand for compensation made","Lawsuit filed","Other"],"wrapperClass":"side-by-side t-items-center","innerClass":"select-height-content"},{"$formkit":"radio","validation":"required","validationMessages":{"required":"Field is required"},"optionsClass":"md:t-ml-4 t-grid t-grid-cols-1 md:t-grid-cols-2-125","legendClass":"legend-left-flex md:t-max-w-[40%] required","label":"Primary Injury:","name":"Primary_Injury","options":["Anxiety","Back or Neck Pain","Broken Bones","Cuts and Bruises","Headaches","Memory Loss","Loss of Limb","Other (describe on next page)"],"fieldsetClass":"$reset side-by-side-flex","innerClass":"t-flex t-items-start","wrapperClass":"$reset t-flex t-cursor-pointer t-mb-3"},{"$formkit":"select","placeholder":"Please Select","validation":"required","validationMessages":{"required":"Field is required"},"inputClass":"t-bg-white","labelClass":"required","label":"Cause of Injury:","name":"Cause_Of_Injury","options":["Traumatic Physical Injury (Accident)","Repeated Trauma Injury","Mental Injury","Occupational Disease","Not Sure"],"wrapperClass":"side-by-side t-items-center","innerClass":"select-height-content"},{"$formkit":"radio","validation":"required","validationMessages":{"required":"Field is required"},"optionsClass":"t-mt-1 t-grid t-grid-cols-1 md:t-grid-cols-2-125 t-items-center","legendClass":"legend-left t-pb-1 required","name":"Doctor_Treatment","label":"Have You Recently Been Treated by a Doctor, Hospital or Clinic?","options":["Yes","No"],"fieldsetClass":"$reset side-by-side t-items-center","innerClass":"t-flex t-items-center"}]},{"$cmp":"FormKit","props":{"type":"group","key":"WrongfulDeathQuestions","id":"WrongfulDeathQuestions","name":"WrongfulDeathQuestions"},"if":"$get(Type_Of_Legal_Problem).value == \"Wrongful Death\"","children":[{"$formkit":"radio","validation":"required","validationMessages":{"required":"Field is required"},"optionsClass":"t-mt-1 t-grid t-grid-cols-1 md:t-grid-cols-2-125 t-items-center","legendClass":"legend-left t-pb-1 required","name":"Have_Attorney","label":"Are You Currently Working with An Attorney?","options":["Yes","No"],"fieldsetClass":"$reset side-by-side t-items-center","innerClass":"t-flex t-items-center"},{"$formkit":"date","validation":"required","validationMessages":{"required":"Field is required"},"labelClass":"required","label":"Date of Incident:","name":"Incident_Date","wrapperClass":"side-by-side t-items-center"},{"$formkit":"select","placeholder":"Please Select","validation":"required","validationMessages":{"required":"Field is required"},"inputClass":"t-bg-white","labelClass":"required","label":"Relationship to the Victim:","name":"Relationship_To_Victim","options":["Parent","Spouse","Sibling","Friend","Other"],"wrapperClass":"side-by-side t-items-center","innerClass":"select-height-content"},{"$formkit":"radio","validation":"required","validationMessages":{"required":"Field is required"},"optionsClass":"t-pl-1","legendClass":"legend-left required","name":"Criminal_Charges_Filed","label":"Were Criminal Charges Filed?","options":["Yes","No","Not Sure"],"fieldsetClass":"$reset side-by-side","innerClass":"t-flex t-items-center","wrapperClass":"t-mb-3"},{"$formkit":"select","placeholder":"Please Select","validation":"required","validationMessages":{"required":"Field is required"},"inputClass":"t-bg-white","labelClass":"required","label":"What was the Cause of the Victim's Death?","name":"Cause_Of_Death","options":["Vehicle Accident","Negligent/Careless Act","Reckless Act","Other"],"wrapperClass":"side-by-side t-items-center","innerClass":"select-height-content"}]},{"$cmp":"FormKit","props":{"type":"group","key":"WrongfulTerminationQuestions","id":"WrongfulTerminationQuestions","name":"WrongfulTerminationQuestions"},"if":"$get(Type_Of_Legal_Problem).value == \"Wrongful Termination\"","children":[{"$formkit":"radio","validation":"required","validationMessages":{"required":"Field is required"},"optionsClass":"t-mt-1 t-grid t-grid-cols-1 md:t-grid-cols-2-125 t-items-center","legendClass":"legend-left t-pb-1 required","name":"Have_Attorney","label":"Are You Currently Working with An Attorney?","options":["Yes","No"],"fieldsetClass":"$reset side-by-side t-items-center","innerClass":"t-flex t-items-center"},{"$formkit":"select","placeholder":"Please Select","validation":"required","validationMessages":{"required":"Field is required"},"inputClass":"t-bg-white","labelClass":"required","label":"Total Employees of Business? (estimated)","name":"Num_Employees_Of_Business","options":["1-5","6-20","21-50","51-100","101-500","501-1,000","More than 1,000"],"wrapperClass":"side-by-side t-items-center","innerClass":"select-height-content"},{"$formkit":"select","placeholder":"Please Select","validation":"required","validationMessages":{"required":"Field is required"},"inputClass":"t-bg-white","labelClass":"required","label":"The Employer Is a:","name":"Employer_Type","options":["Sole proprietorship (mom and pop)","Partnership","Franchise","Privately held company","Public corporation","Government Agency","Don't know"],"wrapperClass":"side-by-side t-items-center","innerClass":"select-height-content"},{"$formkit":"select","placeholder":"Please Select","validation":"required","validationMessages":{"required":"Field is required"},"inputClass":"t-bg-white","labelClass":"required","label":"How Likely Are You to Pay if Your Issue Could be Resolved?","name":"Degree_Of_Interest","help":"No payment necessary to speak with lawyers.","options":["Definitely","Probably","Maybe","Absolutely Can't Afford"],"wrapperClass":"side-by-side t-items-center","innerClass":"select-height-content"}]},{"$cmp":"FormKit","props":{"type":"group","key":"NotSureOrOtherQuestions","id":"NotSureOrOtherQuestions","name":"NotSureOrOtherQuestions"},"if":"$get(Type_Of_Legal_Problem).value == \"Not Sure or Other\"","children":[{"$formkit":"radio","validation":"required","validationMessages":{"required":"Field is required"},"optionsClass":"t-mt-1 t-grid t-grid-cols-1 md:t-grid-cols-2-125 t-items-center","legendClass":"legend-left t-pb-1 required","name":"Have_Attorney","label":"Are You Currently Working with An Attorney?","options":["Yes","No"],"fieldsetClass":"$reset side-by-side t-items-center","innerClass":"t-flex t-items-center"},{"$formkit":"select","placeholder":"Please Select","validation":"required","validationMessages":{"required":"Field is required"},"inputClass":"t-bg-white","labelClass":"required","label":"How Likely Are You to Pay if Your Issue Could be Resolved?","name":"Degree_Of_Interest","help":"No payment necessary to speak with lawyers.","options":["Definitely","Probably","Maybe","Absolutely Can't Afford"],"wrapperClass":"side-by-side t-items-center","innerClass":"select-height-content"}]}]}]},{"$el":"section","if":"$stepIsEnabled(\"comments\")","attrs":{"style":{"if":"$activeStep !== \"comments\"","then":"display: none;"}},"children":[{"$formkit":"group","id":"comments","name":"comments","children":[{"$formkit":"textarea","label":"Please provide a brief description of your situation:","name":"Comments","placeholder":"For Example: \"I would like help with child support payments\" or \"I need help with visitation rights\"","rows":7,"validation":"required","maxlength":1000,"labelClass":"required","validationMessages":{"required":"Description is required"}}]}]},{"$el":"section","if":"$stepIsEnabled(\"firstAndLast\")","attrs":{"style":{"if":"$activeStep !== \"firstAndLast\"","then":"display: none;"}},"children":[{"$formkit":"group","id":"firstAndLast","name":"firstAndLast","children":[{"$formkit":"text","validation":"required","validationMessages":{"required":"First Name is required"},"labelClass":"required","label":"First Name:","name":"First_Name","wrapperClass":"side-by-side t-items-center"},{"$formkit":"text","validation":"required","validationMessages":{"required":"Last Name is required"},"labelClass":"required","label":"Last Name:","name":"Last_Name","wrapperClass":"side-by-side t-items-center"}]}]},{"$el":"section","if":"$stepIsEnabled(\"contactInfo\")","attrs":{"style":{"if":"$activeStep !== \"contactInfo\"","then":"display: none;"}},"children":[{"$formkit":"group","id":"contactInfo","name":"contactInfo","children":[{"$el":"h3","children":"Based on your input, you may benefit from speaking with a family lawyer. Please verify your contact information:","attrs":{"class":"t-flex t-justify-center t-text-center t-text-lg t-font-bold t-pb-5 t-pt-0 t-px-3"}},{"$formkit":"email","validation":"required|email","validationMessages":{"required":"Email is required","email":"Invalid Email"},"labelClass":"required","name":"Email","label":"Email Address:","placeholder":"email@domain.com","wrapperClass":"side-by-side t-items-center"},{"$formkit":"tel","validation":"required|matches:/^[0-9]{3}-?[0-9]{3}-?[0-9]{4}$/","validationMessages":{"required":"Phone Number is required","matches":"Invalid Phone Number"},"labelClass":"required","name":"Primary_Phone","label":"Phone Number:","placeholder":"xxx-xxx-xxxx","maxlength":12,"wrapperClass":"side-by-side t-items-center"},{"$formkit":"checkbox","label":"$meta.tcpaLanguage","name":"TCPA_Opt_In","validation":"required|accepted","validationMessages":{"required":"Consent is required","accepted":"Consent is required"},"classes":{"label":"t-text-xs t-text-slate-500 t-font-normal"}},{"$el":"div","if":"$activeStep === $lastStep()","attrs":{"class":"t-flex t-justify-center"},"children":[{"$el":"img","attrs":{"loading":"lazy","alt":"","style":{"border":0},"src":"https://d27hmee62k45vz.cloudfront.net/form-secure-privacy.png","width":"320","height":"100"}}]}]}]},{"$el":"div","attrs":{"class":"step-nav"},"children":[{"$formkit":"button","onClick":"$setPreviousStep()","children":"Back","style":{"if":"$activeStep === $firstStep()","then":"visibility: hidden;"}},{"$formkit":"button","onClick":"$setNextStep($fireStepEvent($get(form)))","children":"Next","style":{"if":"$activeStep === $lastStep()","then":"display: none;"}},{"$formkit":"submit","label":"Submit","if":"$activeStep === $lastStep()","style":{"if":"$activeStep !== $lastStep()","then":"display: none;"}}]},{"$el":"pre","if":"$urlParam(\"fdbg\", \"\") == 1","children":[{"$el":"pre","children":"$stringify( $get(form).value )","attrs":{"class":"t-text-xs","style":"overflow: scroll"}},{"$el":"pre","children":["activeStep: ","$activeStep"],"attrs":{"class":"t-text-xs","style":"overflow: scroll"}},{"$el":"pre","children":["stepHistory: ","$stepHistory"],"attrs":{"class":"t-text-xs","style":"overflow: scroll"}},{"$el":"pre","children":["stepQueue: ","$stepQueue"],"attrs":{"class":"t-text-xs","style":"overflow: scroll"}}]}]}]}]
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@@ -16,7 +16,7 @@ const formPropDefaults = {
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formClass: '!t-max-w-
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formClass: '!t-max-w-[38rem]'
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function formProps(updates) {
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const sbsText = (updates) => {
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updates.labelClass = 'required';
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return text(updates)
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// ------ Inputs
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validation: 'required',
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options: [
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const firstName = () => sbsText({
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label: 'First Name:',
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name: 'First_Name',
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validation: 'required',
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validationMessages: {
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required: 'First Name is required'
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const email = () => sbsText({
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name: 'Email',
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@@ -127,11 +112,19 @@ const email = () => sbsText({
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}
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const firstName = () => sbsText({
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$formkit: 'text',
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label: 'First Name:',
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name: 'First_Name',
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validationMessages: {
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required: 'First Name is required'
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}
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const lastName = () => sbsText({
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label: 'Last Name:',
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name: 'Last_Name',
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validation: 'required',
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required: 'Last Name is required'
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@@ -170,6 +163,7 @@ const zipcode = () => sbsText({
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name: 'Zip',
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maxlength: 5,
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inputmode: "numeric",
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validation: 'required|matches:/^[0-9]{5}$/',
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validationMessages: {
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required: 'Zip Code is required',
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