{
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  "sources": ["ssg:https://framerusercontent.com/modules/cbFAwE9V0gku0Istps8H/9TSbAzraVCVkhbAHazN1/Email_Form.js"],
  "sourcesContent": ["import{jsx as _jsx,jsxs as _jsxs}from\"react/jsx-runtime\";import{useState,useRef}from\"react\";import emailjs from\"emailjs-com\";export function CarePlanGenerator(){const form=useRef();const[currentStep,setCurrentStep]=useState(1);const[serviceType,setServiceType]=useState(\"\");const[zipCode,setZipCode]=useState(\"\");const[term,setTerm]=useState(\"\");const[additionalInfo,setAdditionalInfo]=useState(\"\");const[needsAndDuties,setNeedsAndDuties]=useState([]);const[lovedOneCondition,setLovedOneCondition]=useState([]);const[firstName,setFirstName]=useState(\"\");const[lastName,setLastName]=useState(\"\");const[email,setEmail]=useState(\"\");const[phone,setPhone]=useState(\"\");const[validationError,setValidationError]=useState(false);const[submissionSuccess,setSubmissionSuccess]=useState(false);const needsAndDutiesOptions=[\"Bathing Grooming / Hygiene\",\"Light Housekeeping\",\"Meal Planning and Prep\",\"Errands\",\"Medication Reminders\",\"Exercise\",\"Companionship\",\"Memory Care / Cognitive exercises\",];const lovedOneConditionOptions=[\"General Aging\",\"Memory Loss\",\"Post Surgery\",\"Not Ambulatory\",\"Post Stroke\",\"Parkinson's\",\"Other\",];const handleFormSubmit=e=>{e.preventDefault();// Join the selected checkboxes into a single string\nconst joinedNeedsAndDuties=needsAndDuties.join(\", \");const joinedLovedOneCondition=lovedOneCondition.join(\", \");// Create the form data object with the updated values\nconst formData={serviceType,zipCode,term,additionalInfo,needsAndDuties:joinedNeedsAndDuties,lovedOneCondition:joinedLovedOneCondition,firstName,lastName,email,phone};// Send form submission via EmailJS\nemailjs.sendForm(\"service_owsas3r\",\"template_vb6yv66\",form.current,\"qJ4lYmny9v1TB7cqR\").then(response=>{console.log(\"Form submitted successfully!\",response.text);setSubmissionSuccess(true);}).catch(error=>{console.error(\"Error submitting form:\",error);});};const formStyle={fontFamily:\"Syne, sans-serif\",display:\"flex\",flexDirection:\"column\",justify:\"center\",align:\"center\",maxWidth:\"900px\",minWidth:\"300px\",height:\"auto\",margin:\"0 auto\",padding:\"20px\",border:\"1px solid #ccc\",borderRadius:\"5px\"};const labelStyle={marginBottom:\"5px\",fontWeight:\"bold\"};const inputStyle={marginBottom:\"10px\",padding:\"5px\",border:\"1px solid #ccc\",borderRadius:\"3px\",fontFamily:\"Syne, sans-serif\"};const buttonStyle={backgroundColor:\"#009688\",color:\"#fff\",margin:\"10px\",padding:\"10px\",border:\"none\",borderRadius:\"3px\",cursor:\"pointer\",fontFamily:\"Syne, sans-serif\"};const stepIndicatorStyle={margin:\"10px 0\",fontWeight:\"bold\",fontSize:\"18px\"};const feedbackStyle={marginTop:\"10px\",textAlign:\"center\",fontWeight:\"bold\"};const errorStyle={color:\"red\"};const checkboxContainerStyle={display:\"flex\",flexDirection:\"column\"};const checkboxLabelStyle={marginBottom:\"5px\"};const handleCheckboxChange=e=>{const{value,checked}=e.target;if(checked){setNeedsAndDuties(prevOptions=>[...prevOptions,value]);}else{setNeedsAndDuties(prevOptions=>prevOptions.filter(option=>option!==value));}};const handleConditionCheckboxChange=e=>{const{value,checked}=e.target;if(checked){setLovedOneCondition(prevOptions=>[...prevOptions,value]);}else{setLovedOneCondition(prevOptions=>prevOptions.filter(option=>option!==value));}};return /*#__PURE__*/ _jsx(\"div\",{children:/*#__PURE__*/ _jsxs(\"form\",{onSubmit:handleFormSubmit,style:formStyle,ref:form,children:[/*#__PURE__*/ _jsx(\"label\",{htmlFor:\"serviceType\",style:labelStyle,children:\"What type of service do you need?\"}),/*#__PURE__*/ _jsxs(\"select\",{id:\"serviceType\",name:\"service_type\",value:serviceType,onChange:e=>setServiceType(e.target.value),required:true,style:inputStyle,children:[/*#__PURE__*/ _jsx(\"option\",{value:\"\",children:\"Select an option\"}),/*#__PURE__*/ _jsx(\"option\",{value:\"Hourly\",children:\"Hourly\"}),/*#__PURE__*/ _jsx(\"option\",{value:\"Live In Care\",children:\"Live in care\"}),/*#__PURE__*/ _jsx(\"option\",{value:\"Visits\",children:\"Visits\"})]}),/*#__PURE__*/ _jsx(\"label\",{htmlFor:\"zipCode\",style:labelStyle,children:\"Where do you need this service? (Zip Code)\"}),/*#__PURE__*/ _jsx(\"input\",{type:\"text\",id:\"zipCode\",name:\"zip_code\",value:zipCode,onChange:e=>setZipCode(e.target.value),required:true,style:inputStyle}),/*#__PURE__*/ _jsx(\"label\",{htmlFor:\"term\",style:labelStyle,children:\"Select a term that suits your needs\"}),/*#__PURE__*/ _jsxs(\"select\",{id:\"term\",name:\"term\",value:term,onChange:e=>setTerm(e.target.value),required:true,style:inputStyle,children:[/*#__PURE__*/ _jsx(\"option\",{value:\"\",children:\"Select an option\"}),/*#__PURE__*/ _jsx(\"option\",{value:\"Long Term\",children:\"Longterm\"}),/*#__PURE__*/ _jsx(\"option\",{value:\"Until Independent\",children:\"Until I'm independent\"}),/*#__PURE__*/ _jsx(\"option\",{value:\"Short Term\",children:\"Short Term\"}),/*#__PURE__*/ _jsx(\"option\",{value:\"As Needed\",children:\"As Needed\"})]}),/*#__PURE__*/ _jsx(\"label\",{htmlFor:\"additionalInfo\",style:labelStyle,children:\"Additional Information:\"}),/*#__PURE__*/ _jsx(\"textarea\",{name:\"additionalInfo\",id:\"additionalInfo\",value:additionalInfo,onChange:e=>setAdditionalInfo(e.target.value),rows:4,required:true,style:inputStyle}),/*#__PURE__*/ _jsx(\"label\",{htmlFor:\"needsAndDuties\",style:labelStyle,children:\"Needs and Duties:\"}),/*#__PURE__*/ _jsx(\"div\",{style:checkboxContainerStyle,children:needsAndDutiesOptions.map(option=>/*#__PURE__*/ _jsxs(\"label\",{style:checkboxLabelStyle,children:[/*#__PURE__*/ _jsx(\"input\",{type:\"checkbox\",name:\"needsAndDuties\",value:option,checked:needsAndDuties.includes(option),onChange:handleCheckboxChange}),option]},option))}),/*#__PURE__*/ _jsx(\"label\",{htmlFor:\"lovedOneCondition\",style:labelStyle,children:\"What is your loved one's condition?\"}),/*#__PURE__*/ _jsx(\"div\",{style:checkboxContainerStyle,children:lovedOneConditionOptions.map(option=>/*#__PURE__*/ _jsxs(\"label\",{style:checkboxLabelStyle,children:[/*#__PURE__*/ _jsx(\"input\",{type:\"checkbox\",name:\"lovedOneCondition\",value:option,checked:lovedOneCondition.includes(option),onChange:handleConditionCheckboxChange}),option]},option))}),/*#__PURE__*/ _jsx(\"label\",{htmlFor:\"firstName\",style:labelStyle,children:\"First Name\"}),/*#__PURE__*/ _jsx(\"input\",{type:\"text\",id:\"firstName\",name:\"firstName\",value:firstName,onChange:e=>setFirstName(e.target.value),required:true,style:inputStyle}),/*#__PURE__*/ _jsx(\"label\",{htmlFor:\"lastName\",style:labelStyle,children:\"Last Name\"}),/*#__PURE__*/ _jsx(\"input\",{type:\"text\",id:\"lastName\",name:\"lastName\",value:lastName,onChange:e=>setLastName(e.target.value),required:true,style:inputStyle}),/*#__PURE__*/ _jsx(\"label\",{htmlFor:\"email\",style:labelStyle,children:\"Email*\"}),/*#__PURE__*/ _jsx(\"input\",{type:\"email\",name:\"email\",id:\"email\",value:email,onChange:e=>setEmail(e.target.value),required:true,style:inputStyle}),/*#__PURE__*/ _jsx(\"label\",{htmlFor:\"phone\",style:labelStyle,children:\"Phone*\"}),/*#__PURE__*/ _jsx(\"input\",{type:\"tel\",name:\"phone\",id:\"phone\",value:phone,onChange:e=>setPhone(e.target.value),required:true,style:inputStyle}),validationError&&/*#__PURE__*/ _jsx(\"div\",{style:feedbackStyle,children:/*#__PURE__*/ _jsx(\"span\",{style:errorStyle,children:\"Please fill in all the required fields.\"})}),submissionSuccess&&/*#__PURE__*/ _jsx(\"div\",{style:feedbackStyle,children:\"Thank you for your submission!\"}),/*#__PURE__*/ _jsx(\"div\",{children:\"By submitting this form, you consent to receive emails and be contacted by North Pacific Home Care, LLC. Please note that you can withdraw your consent at any time, please refer to our privacy policy.\"}),/*#__PURE__*/ _jsx(\"button\",{type:\"submit\",style:buttonStyle,children:\"Submit\"})]})});}\nexport const __FramerMetadata__ = {\"exports\":{\"CarePlanGenerator\":{\"type\":\"reactComponent\",\"name\":\"CarePlanGenerator\",\"slots\":[],\"annotations\":{\"framerContractVersion\":\"1\"}},\"__FramerMetadata__\":{\"type\":\"variable\"}}}\n//# sourceMappingURL=./Email_Form.map"],
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}