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  '#markup': 'After you submit the form, a care specialist will call you back within XX hours to schedule an appointment.'
hr:
  '#type': webform_horizontal_rule
call:
  '#markup': 'You may also speak with a care specialist directly by calling <a href="tel:XXX-XXX-XXXX">XXX-XXX-XXXX</a> on Monday–Friday between 8:30 am to 5:00 pm EST.'
general:
  '#type': fieldset
  '#title': 'General Information'
  '#title_display': invisible
  '#attributes':
    style: 'background-color: #efefef'
  type:
    '#type': radios
    '#title': 'Who are you?'
    '#options':
      Patient: Patient
      Caregiver: Caregiver
    '#options_display': buttons
    '#required': true
  relationship:
    '#type': webform_select_other
    '#title': 'What is your relationship to the patient?'
    '#options': relationship
    '#states':
      visible:
        ':input[name="type"]':
          value: Caregiver
      required:
        ':input[name="type"]':
          value: Caregiver
caregiver:
  '#type': fieldset
  '#title': 'Your Information'
  '#states':
    visible:
      ':input[name="type"]':
        value: Caregiver
  caregiver_name:
    '#type': webform_flexbox
    caregiver_first_name:
      '#title': 'Your First Name'
      '#type': textfield
      '#states':
        required:
          ':input[name="type"]':
            value: Caregiver
    caregiver_last_name:
      '#title': 'Your Last Name'
      '#type': textfield
      '#states':
        required:
          ':input[name="type"]':
            value: Caregiver
    '#title': 'Your Name'
  caregiver_contact:
    '#type': webform_flexbox
    caregiver_email:
      '#title': 'Your Email'
      '#type': email
      '#states':
        required:
          ':input[name="type"]':
            value: Caregiver
    caregiver_phone:
      '#title': 'Your Phone'
      '#type': tel
      '#placeholder': 000-000-0000
      '#states':
        required:
          ':input[name="type"]':
            value: Caregiver
  caregiver_phone_preferences:
    '#type': webform_custom_composite
    '#title': 'Your Phone Preferences'
    '#description': |
      Please select the best days and times for us to call you.<br/>
      <em>Leave blank if you have no preferences.</em>
      
    '#description_display': before
    '#multiple__min_items': '3'
    '#multiple__sorting': false
    '#multiple__operations': false
    '#multiple__add_more': false
    '#element':
      day:
        '#type': select
        '#options':
          Monday: Monday
          Tuesday: Tuesday
          Wednesday: Wednesday
          Thursday: Thursday
          Friday: Fridate
        '#title': 'Day of the Week'
        '#empty_option': 'Any day of the week'
      time:
        '#type': select
        '#options':
          '8am-10am EST': '8am-10am EST'
          '10am-12pm EST': '10am-12pm EST'
          '12pm-2pm EST': '12pm-2pm EST'
          '2pm-4pm EST': '2pm-4pm EST'
        '#title': 'Time of Day'
        '#empty_option': 'Any time of the day'
patient:
  '#type': fieldset
  '#title': 'Patient Information'
  patient_name:
    '#type': webform_flexbox
    patient_first_name:
      '#title': 'Patient First Name'
      '#type': textfield
      '#required': true
    patient_last_name:
      '#title': 'Patient Last Name'
      '#type': textfield
      '#required': true
  patient_contact:
    '#type': webform_flexbox
    patient_email:
      '#title': 'Patient Email'
      '#type': email
      '#states':
        required:
          ':input[name="type"]':
            '!value': Caregiver
    patient_phone:
      '#title': 'Patient Phone'
      '#type': tel
      '#required': true
      '#placeholder': 000-000-0000
      '#states':
        required:
          ':input[name="type"]':
            '!value': Caregiver
  patient_phone_preferences:
    '#type': webform_custom_composite
    '#title': 'Patient Phone Preferences'
    '#description': |
      Please select the best days and times for us to call the patient.<br/>
      <em>Leave blank if the patient has no preferences.</em>'
      
    '#description_display': before
    '#multiple__min_items': '3'
    '#multiple__sorting': false
    '#multiple__operations': false
    '#multiple__add_more': false
    '#element':
      day:
        '#type': select
        '#options':
          Monday: Monday
          Tuesday: Tuesday
          Wednesday: Wednesday
          Thursday: Thursday
          Friday: Fridate
        '#title': 'Day of the Week'
        '#empty_option': 'Any day of the week'
      time:
        '#type': select
        '#options':
          '8am-10am EST': '8am-10am EST'
          '10am-12pm EST': '10am-12pm EST'
          '12pm-2pm EST': '12pm-2pm EST'
          '2pm-4pm EST': '2pm-4pm EST'
        '#title': 'Time of Day'
        '#empty_option': 'Any time of the day'
appointment:
  '#type': fieldset
  '#title': 'Appointment Information (optional)'
  medical:
    '#type': textarea
    '#title': 'Please provide information about your medical needs'
    '#rows': 3
  insurance:
    '#type': textfield
    '#title': 'Please provide insurance plan name information'''
  referral:
    '#type': checkbox
    '#title': 'Have you been referred by a physician?'
  physician:
    '#type': textarea
    '#title': 'Please provide information about the referring physician'
    '#rows': 3
    '#states':
      visible:
        ':input[name="referral"]':
          checked: true
actions:
  '#type': webform_actions
  '#title': 'Submit button(s)'
  '#submit__label': 'Send Request'
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