{{--Name--}}
{{--Country of Origin & Race--}}
{{--Date of Birth & Phone Number--}}
{{--Address--}}
@include('components.form.input_address', [
'states' => $states,
'address_line1' => 'address_line1',
'address_line2' => 'address_line2',
'city' => 'city',
'state' => 'state_id',
'country' => 'country',
'zip' => 'zip',
])
{{--Pregnant--}}
{{--Family Size--}}
{{--Additional Notes--}}
@include('components.form.textarea_row', [
'name' => 'note',
'label' => 'Additional Notes',
'validation' => 'maxLength="170"',
'label_class' => 'col-md-2',
'input_class' => 'col-md-10',
'optional' => true,
'rows' => 3,
])
{{--Next Step--}}