export default {
    steps: {
        page0: {
          elements: [
            'h4_5',
            'p',
            'm_g_weight_lb',
            'm_g_height_feet',
            'm_g_height_inches',
          ],
        },
        page1: {
          elements: [
            'h4',
            'm_g_expecting',
          ],
        },
        page2: {
          label: '',
          elements: [
            'h4_1',
            'm_g_cond_symptoms_tb_500',
          ],
        },
        page3: {
          label: '',
          elements: [
            'h4_2',
            'm_g_peptide_tehrapies',
          ],
        },
        page4: {
          label: '',
          elements: [
            'h4_3',
            'm_g_injury_cond',
            'caloric_intake',
          ],
        },
        page5: {
          label: '',
          elements: [
            'h4_4',
            'm_g_long_exp_issue',
          ],
        },
        page6: {
          label: '',
          elements: [
            'h4_6',
            'm_g_severity_symptoms',
          ],
        },
        page7: {
          label: '',
          elements: [
            'h4_7',
            'm_g_medical_treatments',
            'm_g_treatments_describe',
          ],
        },
        page8: {
          label: '',
          elements: [
            'h4_8',
            'm_g_chronic_health_cond',
          ],
        },
        page9: {
          label: '',
          elements: [
            'h4_9',
            'm_g_known_allergies',
            'm_g_known_allergies_describe',
          ],
        },
        page10: {
          label: '',
          elements: [
            'h4_10',
            'm_g_other_medications',
            'm_g_other_medications_describe',
            'smoke_alcohol',
          ],
        },
        page11: {
          label: '',
          elements: [
            'h4_11',
            'm_g_physical_activity',
          ],
        },
        page12: {
          label: '',
          elements: [
            'h4_12',
            'm_g_typical_diet',
          ],
        },
        page13: {
          label: '',
          elements: [
            'h4_13',
            'm_g_sleep_quality',
          ],
        },
        page14: {
          label: '',
          elements: [
            'h4_14',
            'm_g_in_person_med_evealuation',
          ],
        },
        page15: {
          label: '',
          elements: [
            'h4_15',
            'm_g_tests_completed',
          ],
        },
        page16: {
          label: '',
          elements: [
            'h4_16',
            'm_g_gastrointestinal_or_metabolic_conditions',
            'm_g_gastrointestinal_or_metabolic_conditions_describe',
          ],
        },
        page17: {
          label: '',
          elements: [
            'h4_17',
            'm_g_thyroid_issues_or_diabetes',
            'm_g_thyroid_issues_or_diabetes_describe',
          ],
        },
        page18: {
          label: '',
          elements: [
            'h3',
            'm_g_systolic_diastolic',
          ],
        },
        page19: {
          label: '',
          elements: [
            'h3_1',
            'm_g_tb_500_therapy',
          ],
        },
      },
      schema: {
        h4_5: {
          type: 'static',
          tag: 'h4',
          content: 'We require that you provide a recent blood pressure measurement within the last six months.',
        },
        p: {
          type: 'static',
          tag: 'p',
          content: 'Blood pressure should be listed as follows:  Systolic (top number) / Diastolic (bottom number).\nIf you are not sure, please go have your blood pressure obtained (often free at your local pharmacy).\n',
        },
        m_g_weight_lb: {
          type: 'text',
          label: 'Weight (lb) (Optional)',
          
        },
        m_g_height_feet: {
          type: 'text',
          label: 'Height (feet) (Optional)',
          
          fieldName: ' ',
          columns: {
            container: 6,
          },
        },
        m_g_height_inches: {
          type: 'text',
          label: 'Height (inches) (Optional)',
          
          fieldName: ' ',
          columns: {
            container: 6,
          },
        },
        h4: {
          type: 'static',
          tag: 'h4',
          content: 'Are you pregnant or expecting to be?',
        },
        m_g_expecting: {
          type: 'radiogroup',
          items: [
            {
              value: 'pregnant',
              label: 'Pregnant',
            },
            {
              value: 'breastfeeding ',
              label: 'Breastfeeding or lactating',
            },
            {
              value: 'expecting_pregnant',
              label: 'Expecting to be pregnant',
            },
            {
              value: 'not_applicable',
              label: 'No or Not Applicable',
            },
          ],
          rules: [
            'validateRadio',
          ],
          fieldName: ' ',
        },
        h4_1: {
          type: 'static',
          tag: 'h4',
          content: 'What specific conditions or symptoms are you seeking treatment for with TB-500?',
        },
        m_g_cond_symptoms_tb_500: {
          type: 'checkboxgroup',
          items: [
            {
              value: 'muscle_injuries',
              label: 'Muscle injuries',
            },
            {
              value: 'joint_pain',
              label: 'Joint pain',
            },
            {
              value: 'tendonitis',
              label: 'Tendonitis',
            },
            {
              value: 'wound_healing',
              label: 'Wound healing',
            },
            {
              value: 'inflammation',
              label: 'Inflammation',
            },
          ],
          rules: [
            'required',
          ],
          fieldName: ' ',
        },
        h4_2: {
          type: 'static',
          tag: 'h4',
          content: 'Have you previously used TB-500 or any other hgh therapies',
        },
        m_g_peptide_tehrapies: {
          type: 'radiogroup',
          items: [
            {
              value: 'yes',
              label: 'Yes',
            },
            {
              value: 'no',
              label: 'No',
            },
          ],
          rules: [
            'validateRadio',
          ],
          fieldName: ' ',
        },
        h4_3: {
          type: 'static',
          tag: 'h4',
          content: 'Describe the nature of your injury or condition:',
        },
        m_g_injury_cond: {
          type: 'text',
          rules: [
            'validateTextBox',
          ],
          fieldName: ' ',

        },
        h4_4: {
          type: 'static',
          tag: 'h4',
          content: 'How long have you been experiencing this issue?',
        },
        m_g_long_exp_issue: {
          type: 'text',
          rules: [
            'validateTextBox',
          ],
          fieldName: ' ',
        },
        h4_6: {
          type: 'static',
          tag: 'h4',
          content: 'Can you rate the severity of your symptoms on a scale from 1 to 10?',
        },
        m_g_severity_symptoms: {
          type: 'text',
          rules: [
            'validateTextBox',
          ],
          fieldName: ' ',
        },
        h4_7: {
          type: 'static',
          tag: 'h4',
          content: 'Have you had any recent surgeries or medical treatments for this condition?\n',
        },
        m_g_medical_treatments: {
          type: 'radiogroup',
          items: [
            {
              value: 'yes',
              label: 'Yes',
            },
            {
              value: 'no',
              label: 'No',
            },
          ],
          rules: [
            'validateRadio',
          ],
          fieldName: ' ',
        },
        m_g_treatments_describe: {
          type: 'textarea',
          label: 'Please Describe',
          rules: [
            'validateTextArea',
          ],
          fieldName: ' ',
          conditions: [
            [
              'm_g_medical_treatments',
              'in',
              [
                'yes',
              ],
            ],
          ],
        },
        h4_8: {
          type: 'static',
          tag: 'h4',
          content: 'Do you have any chronic health conditions?',
        },
        m_g_chronic_health_cond: {
          type: 'checkboxgroup',
          items: [
            {
              value: 'high_blood_pressure',
              label: 'High blood pressure',
            },
            {
              value: 'diabetes',
              label: 'Diabetes',
            },
            {
              value: 'cardiovascular_disease',
              label: 'Cardiovascular disease',
            },
            {
              value: 'chronic_renal_failure',
              label: 'Chronic renal failure',
            },
            {
              value: 'none_of_the_above',
              label: 'None of the above',
            },
          ],
          rules: [
            'required',
          ],
          fieldName: ' ',
        },
        h4_9: {
          type: 'static',
          tag: 'h4',
          content: 'Do you have any known allergies, particularly to medications or hgh?',
        },
        m_g_known_allergies: {
          type: 'radiogroup',
          items: [
            {
              value: 'yes',
              label: 'Yes',
            },
            {
              value: 'no',
              label: 'No',
            },
          ],
          rules: [
            'validateRadio',
          ],
          fieldName: ' ',
        },
        m_g_known_allergies_describe: {
          type: 'textarea',
          label: 'Please Describe',
          rules: [
            'validateTextArea',
          ],
          fieldName: ' ',
          conditions: [
            [
              'm_g_known_allergies',
              'in',
              [
                'yes',
              ],
            ],
          ],
        },
        h4_10: {
          type: 'static',
          tag: 'h4',
          content: 'Are you currently taking any other medications or supplements?',
        },
        m_g_other_medications: {
          type: 'radiogroup',
          items: [
            {
              value: 'yes',
              label: 'Yes',
            },
            {
              value: 'no',
              label: 'No',
            },
          ],
          rules: [
            'validateRadio',
          ],
          fieldName: ' ',
        },
        m_g_other_medications_describe: {
          type: 'textarea',
          label: 'Please Describe',
          rules: [
            'validateTextArea',
          ],
          fieldName: ' ',
          conditions: [
            [
              'm_g_other_medications',
              'in',
              [
                'yes',
              ],
            ],
          ],
        },
        smoke_alcohol: {
          type: 'radiogroup',
        },
        h4_11: {
          type: 'static',
          tag: 'h4',
          content: 'What is your current level of physical activity?',
        },
        m_g_physical_activity: {
          type: 'checkboxgroup',
          items: [
            {
              value: 'sedentary',
              label: 'Sedentary',
            },
            {
              value: 'light_exercise',
              label: 'Light exercise (1-2 days per week)',
            },
            {
              value: 'moderate_exercise',
              label: 'Moderate exercise (3-4 days per week)',
            },
            {
              value: 'intense_exercise',
              label: 'Intense exercise (5-7 days per week)',
            },
          ],
          rules: [
            'required',
          ],
          fieldName: ' ',
        },
        h4_12: {
          type: 'static',
          tag: 'h4',
          content: 'Describe your typical diet and any dietary restrictions:',
        },
        m_g_typical_diet: {
          type: 'textarea',
          rules: [
            'validateTextArea',
          ],
          fieldName: ' ',
        },
        h4_13: {
          type: 'static',
          tag: 'h4',
          content: 'How would you describe your sleep quality and patterns?',
        },
        m_g_sleep_quality: {
          type: 'textarea',
          rules: [
            'validateTextArea',
          ],
          fieldName: ' ',
        },
        h4_14: {
          type: 'static',
          tag: 'h4',
          content: 'When was the last time you had an in-person medical evaluation?',
        },
        m_g_in_person_med_evealuation: {
          type: 'checkboxgroup',
          items: [
            {
              value: 'less_than_a_year_ago',
              label: 'Less than a year ago',
            },
            {
              value: '1_to_2_years_ago',
              label: '1 to 2 years ago',
            },
            {
              value: 'more_than_2_years_ago',
              label: 'More than 2 years ago',
            },
          ],
          rules: [
            'required',
          ],
          fieldName: ' ',
        },
        h4_15: {
          type: 'static',
          tag: 'h4',
          content: 'Have you had any lab tests completed within the last 12 months that you would like to share with your doctor?',
        },
        m_g_tests_completed: {
          type: 'radiogroup',
          items: [
            {
              value: 'yes',
              label: 'Yes',
            },
            {
              value: 'no',
              label: 'No, not at this time',
            },
          ],
          rules: [
            'validateRadio',
          ],
          fieldName: ' ',
        },
        h4_16: {
          type: 'static',
          tag: 'h4',
          content: 'Does anyone in your family have a history of gastrointestinal or metabolic conditions?',
        },
        m_g_gastrointestinal_or_metabolic_conditions: {
          type: 'radiogroup',
          items: [
            {
              value: 'yes',
              label: 'Yes',
            },
            {
              value: 'no',
              label: 'No',
            },
          ],
          rules: [
            'validateRadio',
          ],
          fieldName: ' ',
        },
        m_g_gastrointestinal_or_metabolic_conditions_describe: {
          type: 'textarea',
          label: 'Please Describe',
          rules: [
            'validateTextArea',
          ],
          fieldName: ' ',
          conditions: [
            [
              'm_g_gastrointestinal_or_metabolic_conditions',
              'in',
              [
                'yes',
              ],
            ],
          ],
        },
        h4_17: {
          type: 'static',
          tag: 'h4',
          content: 'Does anyone in your family have a history of thyroid issues or diabetes?',
        },
        m_g_thyroid_issues_or_diabetes: {
          type: 'radiogroup',
          items: [
            {
              value: 'yes',
              label: 'Yes',
            },
            {
              value: 'no',
              label: 'No',
            },
          ],
          rules: [
            'validateRadio',
          ],
          fieldName: ' ',
        },
        m_g_thyroid_issues_or_diabetes_describe: {
          type: 'textarea',
          rules: [
            'validateTextArea',
          ],
          fieldName: ' ',
          conditions: [
            [
              'm_g_thyroid_issues_or_diabetes',
              'in',
              [
                'yes',
              ],
            ],
          ],
        },
        h3: {
          type: 'static',
          tag: 'h3',
          content: 'We require that you provide a recent blood pressure measurement within the last six months. Blood pressure should be listed as follows: Systolic (top number) / Diastolic (bottom number). If you are not sure, please go have your blood pressure obtained (often free at your local pharmacy).',
        },
        m_g_systolic_diastolic: {
          type: 'text',
          label: 'Blood Pressure (Systolic/Diastolic):',
          rules: [
            'validateTextBox',
          ],
          fieldName: ' ',
        },
        h3_1: {
          type: 'static',
          tag: 'h3',
          content: 'Is there any other relevant information or concerns you would like to discuss with your doctor regarding TB-500 therapy?',
        },
        m_g_tb_500_therapy: {
          type: 'text',
          rules: [
            'validateTextBox',
          ],
          fieldName: ' ',
        },
      },
}
