<commit_before>{% extends 'FrontendBundle::layout.html.twig' %}
{% set _layoutSpecificContentId = 'inquiry-content'%}

{% block content %}

    <div class="row">
        <div class="span8">
            <form id="inquiryForm" novalidate="novalidate" class="inquiry" method="POST" action="{{ path('frontend_page_inquiry') }}">
                
                <h1>Get In Contact</h1>
                {% if error %}
                    <div class="alert alert-error">
                        {% for each in error_list %}
                        	{{ each }} <br>
                        {% endfor %}
                    </div>
                {% else %}
                    {% for alert, message in app.session.flashes %}
                    	{% if alert == 'warning' %}
                    	    {% set class = '' %}
                    	{% elseif alert == 'error' %}
                    	    {% set class = 'alert-error' %}
                    	{% elseif alert == 'success' %}
                    	    {% set class = 'alert-success' %}
                    	{% elseif (alert == 'notice') or alert == 'info' %}
                    	    {% set class = 'alert-info' %}
                    	{% else %}
                    	    {% set class = '' %}
                    	{% endif %}
                        <div class="alert {{ class }}">
                            {{ message | raw}}
                        </div>
                    {% endfor %}
                {% endif %}
                <section class="section">
                    <div class="row-fluid">
                        <div class="span12">
                            <div class="control-group row-field {{ (form.inquirySubject.vars.valid ? '' : 'error') }}">
                                <label>My request concerns: *</label>
                                {{ form_widget(form.inquirySubject, {attr: {class: 'radio'} })}}
                            </div>
                        </div>
                    </div>
                </section>
                <section class="section">
                    <h2>Personal Details</h2>
                    <div class="row-fluid">
                        <div class="span12">
                            <div class="control-group row-field {{ (form.firstName.vars.valid ? '' : 'error') }}">
                                <label for="inquire_firstName">First Name *</label>
                                {{ form_widget(form.firstName, {attr: {class: 'span12'} } )}}
                            </div>
                            <div class="control-group row-field {{ (form.lastName.vars.valid ? '' : 'error') }}">
                                <label for="inquire_lastName">Last Name *</label>
                                {{ form_widget(form.lastName, {attr: {class: 'span12'} } )}}
                            </div>
                            <div class="row-field {{ (form.country.vars.valid ? '' : 'error') }}">
                                <label for="inquire_country">Country</label>
                                <div class="country-select">
                                    {{ form_widget(form.country )}}
                                </div>
                            </div>
                            <div class="control-group row-field {{ (form.city.vars.valid ? '' : 'error') }}">
                                <label for="inquire_city">City</label>
                                <div class="country-select">
                                    {{ form_widget(form.city, {attr: {class: 'city_dropdown'} } )}}
                                </div>
                            </div>
                            <div class="control-group row-field {{ (form.contactNumber.vars.valid ? '' : 'error') }}">
                                <label for="inquire_contactNumber">Phone</label>
                                {{ form_widget(form.contactNumber, {attr: {class: 'span12'} } )}}
                            </div>
                            <div class="control-group row-field {{ (form.email.vars.valid ? '' : 'error') }}">
                                <label for="inquire_email">Email Address *</label>
                                {{ form_widget(form.email, {attr: {class: 'span12'} } )}}
                            </div>
                            <div class="control-group row-field {{ (form.message.vars.valid ? '' : 'error') }}">
                                <label for="inquire_message">Message *</label>
                                {{ form_widget(form.message, {attr: {class: 'span12', rows: 5, cols: 60} } ) }}
                            </div>
                                                        
                        </div>
                    </div>
                </section>
                <section class="section">
                    <div class="row-fluid terms">
                        <div class="span12">
                            <strong>Legal note:</strong>
                            <p>The data entered into this form is transmitted encrypted to HealthcareAbroad via the internet. Nevertheless, in order to maintain discretion, please do not include any confidential data such as account numbers. Via this form HealthcareAbroad does not accept any instructions for business transactions such as the opening of accounts, payment orders, trading orders, revocations of orders or authorizations, blocking of credit cards, changes of address, etc. Please contact the appropriate office or your client advisor for such transactions.</p>
                            <p>By providing your telephone number and/or e-mail address above you expressly approve HealthcareAbroad contacting you via telephone and/or via unsecured e-mail.</p>
                            <strong>Please note:</strong>
                            <p>The use of e-mail can involve substantial risks such as lack of confidentiality, potential manipulation of contents or sender's address, wrong recipient, viruses etc. HealthcareAbroad assumes no responsibility for any loss or damage resulting from the use of e-mails. HealthcareAbroad recommends in particular that you do not send any sensitive information, that you do not include details of the previous message in any reply, and that you enter e-mail addresses manually every time you write an e-mail.</p>
                            <p>
                                <a href="terms-of-use.html">Terms of Use</a>
                                <a href="privacy-policy">Privacy Policy</a>
                            </p>
                        </div>
                    </div>
                </section>
                <section class="section">
                    <div class="row-fluid">
                        <div class="span12">
                            <div class="control-group row-field {{ (form.inquiryCheck.vars.valid ? '' : 'error') }}">
                                <label>Confirmation</label>
                                <label class="checkbox">
                                    {{ form_widget(form.inquiryCheck) }}
<!--                                     <input id="inquiryCheck" type="checkbox" name="inquiry"> -->
                                    I confirm that I have understood the legal note and have taken note of and accept the given risks as well as the terms of use and the privacy policy relating to the HealthcareAbroad website.
                                </label>
                            </div>
                        </div>
                    </div>
                </section>
                <section class="section">
                    <div class="control-group row-field {{ (form.captcha.vars.valid ? '' : 'error') }}">
                        {{ form_label(form.captcha) }}
                        {{ form_widget(form.captcha) }}
                    </div>
                </section>
                <section>
                    <div class="row-fluid terms">
                        <p>Please complete all fields marked with *</p>
                    </div>
                </section>
                <section class="section footer">
                    <div class="row-fluid terms">
                        <div class="span12">
                            <button class="pull-right btn"> Cancel </button>
                            <button id="inquirySubmit" class="pull-right btn btn-primary orange"> Submit </button>
                        </div>
                    </div>
                </section>
                {{ form_rest(form) }}    
            </form>
        </div>
        <!--End of main_content-->
    </div>
{% endblock %}<commit_msg>Fixed captcha layout in inquiry page<commit_after>{% extends 'FrontendBundle::layout.html.twig' %}
{% set _layoutSpecificContentId = 'inquiry-content'%}

{% block content %}

    <div class="row">
        <div class="span8">
            <form id="inquiryForm" novalidate="novalidate" class="inquiry" method="POST" action="{{ path('frontend_page_inquiry') }}">
                
                <h1>Get In Contact</h1>
                {% if error %}
                    <div class="alert alert-error">
                        {% for each in error_list %}
                        	{{ each }} <br>
                        {% endfor %}
                    </div>
                {% else %}
                    {% for alert, message in app.session.flashes %}
                    	{% if alert == 'warning' %}
                    	    {% set class = '' %}
                    	{% elseif alert == 'error' %}
                    	    {% set class = 'alert-error' %}
                    	{% elseif alert == 'success' %}
                    	    {% set class = 'alert-success' %}
                    	{% elseif (alert == 'notice') or alert == 'info' %}
                    	    {% set class = 'alert-info' %}
                    	{% else %}
                    	    {% set class = '' %}
                    	{% endif %}
                        <div class="alert {{ class }}">
                            {{ message | raw}}
                        </div>
                    {% endfor %}
                {% endif %}
                <section class="section">
                    <div class="row-fluid">
                        <div class="span12">
                            <div class="control-group row-field {{ (form.inquirySubject.vars.valid ? '' : 'error') }}">
                                <label>My request concerns: *</label>
                                {{ form_widget(form.inquirySubject, {attr: {class: 'radio'} })}}
                            </div>
                        </div>
                    </div>
                </section>
                <section class="section">
                    <h2>Personal Details</h2>
                    <div class="row-fluid">
                        <div class="span12">
                            <div class="control-group row-field {{ (form.firstName.vars.valid ? '' : 'error') }}">
                                <label for="inquire_firstName">First Name *</label>
                                {{ form_widget(form.firstName, {attr: {class: 'span12'} } )}}
                            </div>
                            <div class="control-group row-field {{ (form.lastName.vars.valid ? '' : 'error') }}">
                                <label for="inquire_lastName">Last Name *</label>
                                {{ form_widget(form.lastName, {attr: {class: 'span12'} } )}}
                            </div>
                            <div class="row-field {{ (form.country.vars.valid ? '' : 'error') }}">
                                <label for="inquire_country">Country</label>
                                <div class="country-select">
                                    {{ form_widget(form.country )}}
                                </div>
                            </div>
                            <div class="control-group row-field {{ (form.city.vars.valid ? '' : 'error') }}">
                                <label for="inquire_city">City</label>
                                <div class="country-select">
                                    {{ form_widget(form.city, {attr: {class: 'city_dropdown'} } )}}
                                </div>
                            </div>
                            <div class="control-group row-field {{ (form.contactNumber.vars.valid ? '' : 'error') }}">
                                <label for="inquire_contactNumber">Phone</label>
                                {{ form_widget(form.contactNumber, {attr: {class: 'span12'} } )}}
                            </div>
                            <div class="control-group row-field {{ (form.email.vars.valid ? '' : 'error') }}">
                                <label for="inquire_email">Email Address *</label>
                                {{ form_widget(form.email, {attr: {class: 'span12'} } )}}
                            </div>
                            <div class="control-group row-field {{ (form.message.vars.valid ? '' : 'error') }}">
                                <label for="inquire_message">Message *</label>
                                {{ form_widget(form.message, {attr: {class: 'span12', rows: 5, cols: 60} } ) }}
                            </div>
                                                        
                        </div>
                    </div>
                </section>
                <section class="section">
                    <div class="row-fluid terms">
                        <div class="span12">
                            <strong>Legal note:</strong>
                            <p>The data entered into this form is transmitted encrypted to HealthcareAbroad via the internet. Nevertheless, in order to maintain discretion, please do not include any confidential data such as account numbers. Via this form HealthcareAbroad does not accept any instructions for business transactions such as the opening of accounts, payment orders, trading orders, revocations of orders or authorizations, blocking of credit cards, changes of address, etc. Please contact the appropriate office or your client advisor for such transactions.</p>
                            <p>By providing your telephone number and/or e-mail address above you expressly approve HealthcareAbroad contacting you via telephone and/or via unsecured e-mail.</p>
                            <strong>Please note:</strong>
                            <p>The use of e-mail can involve substantial risks such as lack of confidentiality, potential manipulation of contents or sender's address, wrong recipient, viruses etc. HealthcareAbroad assumes no responsibility for any loss or damage resulting from the use of e-mails. HealthcareAbroad recommends in particular that you do not send any sensitive information, that you do not include details of the previous message in any reply, and that you enter e-mail addresses manually every time you write an e-mail.</p>
                            <p>
                                <a href="terms-of-use.html">Terms of Use</a>
                                <a href="privacy-policy">Privacy Policy</a>
                            </p>
                        </div>
                    </div>
                </section>
                <section class="section">
                    <div class="row-fluid">
                        <div class="span12">
                            <div class="control-group row-field {{ (form.inquiryCheck.vars.valid ? '' : 'error') }}">
                                <label>Confirmation</label>
                                <label class="checkbox">
                                    {{ form_widget(form.inquiryCheck) }}
<!--                                     <input id="inquiryCheck" type="checkbox" name="inquiry"> -->
                                    I confirm that I have understood the legal note and have taken note of and accept the given risks as well as the terms of use and the privacy policy relating to the HealthcareAbroad website.
                                </label>
                            </div>
                        </div>
                    </div>
                </section>
                <section class="section">
                    <div class="captcha control-group row-field {{ (form.captcha.vars.valid ? '' : 'error') }}">
                        {{ form_label(form.captcha) }}
                        {{ form_widget(form.captcha) }}
                    </div>
                </section>
                <section>
                    <div class="row-fluid terms">
                        <p>Please complete all fields marked with *</p>
                    </div>
                </section>
                   {{ form_rest(form) }}    
                <section class="section footer">
                    <div class="row-fluid terms">
                        <div class="span12">
                            <button class="pull-right btn"> Cancel </button>
                            <button id="inquirySubmit" class="pull-right btn btn-primary orange"> Submit </button>
                        </div>
                    </div>
                </section>
            </form>
        </div>
        <!--End of main_content-->
    </div>
{% endblock %}
{'fraction_non_alphanumeric': 0.11662817551963048, 'fraction_numerical': 0.003233256351039261, 'mean_word_length': 1.1415677546983185, 'pattern_counts': {'":': 0, '<': 243, '<?xml version=': 0, '>': 243, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 30, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
{'dir': 'git-commits-cleaned', 'id': '681858', 'n_tokens_mistral': 4193, 'n_tokens_neox': 3810, 'n_words': 1054}