from flask_wtf import Form

from wtforms import TextField, IntegerField, BooleanField, TextAreaField, SubmitField, RadioField, SelectField, SelectMultipleField

from wtforms import validators, ValidationError

from os import listdir

class ClientForm(Form):

print("FORM")

folders = listdir("app/static/demo_documents")

print(folders)

PDFS = {

"aaatest":

[

],

"aarp":

[

],

"aetna":

[

],

"alignment":

[

],

"anthem":

[

],

"other": []

}

for folder in folders:

files = listdir("app/static/demo_documents/" + folder)

for file in files:

path = "app/static/demo_documents/" + folder + "/" + file

file_name = folder + "/" + file + "/" + listdir(path)[0]

PDFS[folder.lower()].append( (file_name, file) )

providers = []

for key, value in PDFS.items():

print(key)

providers.append( (key, key) )

pdf_providers = SelectField('PDF Provider', [validators.Required("Please choose a PDF file.")], choices = providers, render_kw={'onchange': "choosePDF()"})

pdf_aaatest = SelectField('PDF Name', choices = PDFS["aaatest"])

pdf_aarp = SelectField('PDF Name', choices = PDFS["aarp"])

pdf_aetna = SelectField('PDF Name', choices = PDFS["aetna"])

pdf_alignment = SelectField('PDF Name', choices = PDFS["alignment"])

pdf_anthem = SelectField('PDF Name', choices = PDFS["anthem"])

include_SOA = BooleanField('Include Scope of Appointment PDF')

title = RadioField('Title', choices = [('Mr','Mr'),('Ms','Ms'),('Mrs','Mrs')])

first_name = TextField("First Name ",[validators.Required("Please enter your first name.")])

middle_initial = TextField("Middle Initial ")

last_name = TextField("Last Name ",[validators.Required("Please enter your last name.")])

home_address = TextField("Home Address")

city = TextField("City")

state = TextField("State")

zip = TextField("Zip Code")

diff_mail_addr = BooleanField('Different mailing address?')

mailing_address = TextField("Mailing Address")

mailing_city = TextField("City")

mailing_state = TextField("State")

mailing_zip = TextField("Zip Code")

home_tel = TextField("Phone Number")

email = TextField("Email",[validators.Required("Please enter your email address."),

validators.Email("Please enter your email address.")])

dob = TextField("Date of Birth ")

aarp = TextField("AARP Membership # (Only required if you are enrolling in a AARP Medicare Supplement plan)")

add_coverage = SelectMultipleField("Would you like to add additional coverage if not already included in your plan?", choices = [('Dental', 'Dental Coverage'), ('Vision', 'Vision Coverage'), ('More', "I'd like to learn more")] )

claim_num = TextField("Medicare Claim Number")

MONTHS = [('Jan','January'),('Feb','February'),('Mar','March'),

('Apr','April'),('May','May'),('Jun','June'),

('Jul','July'),('Aug','August'),('Sep','September'),

('Oct','October'),('Nov','November'),('Dec','December'), ]

YEARS = [('2020','2020'),('2019','2019'),('2018','2018'),

('2017','2017'),('2016','2016'),('2015','2015'),

('2014','2014'),('2013','2013'),('2012','2012'),

('2011','2011'),('2010','2010'),('2009','2009'),

('2008','2008'),('2007','2007'),('2006','2006'),

('2005','2005') ]

hospital_month = SelectField("Month", choices = MONTHS )

hospital_year = SelectField("Year", choices = YEARS )

medical_month = SelectField("Month", choices = MONTHS )

medical_year = SelectField("Year", choices = YEARS )

plan_type = SelectField("Type of plan", choices = [('None','None'),('Emp','Employer Group Plan'),('Ind','Individual Plan'),

('Uni','Union Plan'),('Oth','Other') ] )

ins_company = TextField("Health insurance company")

policy_id = TextField("Health insurance policy ID #")

ins_start_date = TextField("Health insurance start date (Best estimation if you can't find it)")

ins_end_date = TextField("Health insurance end date (leave blank if your health insurance is still active)")

pref_payment = SelectField("How would you prefer to pay?", choices = [('Mon','Monthly billing by the health insurance company'),

('Soc','Social Security check deduction (Not for Medicare Supplement Plans)'),

('Dir','Direct Debit') ] )

bank_name = TextField("Bank Name")

account_number = TextField("Account Number")

routing_number = TextField("Routing Number")

submit = SubmitField("Submit")