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| 1 | +{% set serviceHome = '/design/start' %} |
| 2 | +{% set servicePhase = 'beta' %} |
| 3 | +{% set feedbackType = 'step' %} |
| 4 | + |
| 5 | +{% extends 'layout.html' %} |
| 6 | + |
| 7 | +{% block pageTitle %} |
| 8 | +Share your contact details - {{ ServiceName }} - NHS |
| 9 | +{% endblock %} |
| 10 | + |
| 11 | +{% block outerContent %} |
| 12 | + {{ backLink({ |
| 13 | + "href": "javascript:history.go(-1)", |
| 14 | + "text": "Go back", |
| 15 | + "classes": "nhsuk-u-margin-top-4 nhsuk-u-margin-bottom-0" |
| 16 | + }) }} |
| 17 | +{% endblock %} |
| 18 | + |
| 19 | +{% block content %} |
| 20 | + |
| 21 | + <div class="nhsuk-grid-row"> |
| 22 | + <div class="nhsuk-grid-column-two-thirds"> |
| 23 | + |
| 24 | + <form action="" method="post" autocomplete="off"> |
| 25 | + |
| 26 | + <h1 class="nhsuk-heading-l">Share your contact details</h1> |
| 27 | + |
| 28 | + <p>By sharing you confirm that these details:</p> |
| 29 | + <ul> |
| 30 | + <li>will be updated on your health record</li> |
| 31 | + <li>your new GP surgery can use them to contact you</li> |
| 32 | + </ul> |
| 33 | + |
| 34 | + {{ hint({ |
| 35 | + "text": "You have agreed to share these details with the Register with a GP Surgery service.", |
| 36 | + "classes": "nhsuk-u-margin-bottom-4" |
| 37 | + }) }} |
| 38 | + |
| 39 | + <dl class="nhsuk-summary-list"> |
| 40 | + |
| 41 | + <div class="nhsuk-summary-list__row"> |
| 42 | + <dt class="nhsuk-summary-list__key"> |
| 43 | + UK mobile telephone number |
| 44 | + </dt> |
| 45 | + <dd class="nhsuk-summary-list__value"> |
| 46 | + 07799123456 |
| 47 | + </dd> |
| 48 | + </div> |
| 49 | + |
| 50 | + <div class="nhsuk-summary-list__row"> |
| 51 | + <dt class="nhsuk-summary-list__key"> |
| 52 | + Email address |
| 53 | + </dt> |
| 54 | + <dd class="nhsuk-summary-list__value"> |
| 55 | + |
| 56 | + </dd> |
| 57 | + </div> |
| 58 | + |
| 59 | + </dl> |
| 60 | + |
| 61 | + <div class="nhsuk-inset-text"> |
| 62 | + <span class="nhsuk-u-visually-hidden">Information: </span> |
| 63 | + <p>You can update your contact details by visiting <a href="https://settings.login.nhs.uk/" target="_blank" rel="noopener noreferrer" title="External website">managing your NHS login (opens in new tab)</a>.</p> |
| 64 | + </div> |
| 65 | + |
| 66 | + {{ radios({ |
| 67 | + "idPrefix": "use-contacts-login", |
| 68 | + "name": "use-contacts-login", |
| 69 | + "classes": "nhsuk-radios", |
| 70 | + "fieldset": { |
| 71 | + "legend": { |
| 72 | + "text": "Do you want to share these details?", |
| 73 | + "classes": "nhsuk-fieldset__legend--m", |
| 74 | + "isPageHeading": true |
| 75 | + } |
| 76 | + }, |
| 77 | + "items": [ |
| 78 | + { |
| 79 | + "value": "Yes~/design/how-can-we-contact-you", |
| 80 | + "text": "Yes, share these details" |
| 81 | + }, |
| 82 | + { |
| 83 | + "value": "No~/design/how-can-we-contact-inputs", |
| 84 | + "text": "No, share different details" |
| 85 | + } |
| 86 | + ] |
| 87 | + }) }} |
| 88 | + |
| 89 | + {{ button({ |
| 90 | + "text": "Continue" |
| 91 | + }) }} |
| 92 | + |
| 93 | + </form> |
| 94 | + </div> |
| 95 | + </div> |
| 96 | + |
| 97 | +{% endblock %} |
| 98 | + |
| 99 | +{% block footer %} |
| 100 | + {% include 'design/includes/footer.html' %} |
| 101 | +{% endblock %} |
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