<div class="modal-header">
		<button type="button" class="close" data-dismiss="modal" aria-hidden="true" aria-label="close">
			<span aria-hidden="true">&times;</span>
		</button>
		<h4 class="modal-title">{$_st}</h4>
	</div>

	{if isset($question)}
		{assign var="form_url" value="{$_url}module_forms/questions/update"}
	{else}
		{assign var="form_url" value="{$_url}module_forms/questions/create"}
	{/if}

	<div class="modal-body">
		<form class="form-horizontal" name="form-question-preview" id="form-question-preview"
			  method="post" action="{$form_url}">

			{if isset($form_id)}
				<input type="hidden" name="form_id" value="{$form_id}">
			{/if}

			{if isset($question)}
				<input type="hidden" name="question_id" value="{$question->id}">
				<input type="hidden" name="sorder" value="{$question->sorder}">
			{/if}

			<div class="row">

				<div class="col-md-4">
					<div class="row">

						<div class="col-md-12 options-header"><span>Header</span></div>

						<div class="col-md-12" id="question-container"
							 data-question_id="{if isset($question)}{$question->id}{/if}"
							 data-sorder="{if isset($question)}{$question->sorder}{/if}"
							 data-type="{if isset($question)}{$question->type}{/if}"
							 data-type_id="{if isset($question)}{$question->type_id}{/if}">

							<div class="form-group">
								<label for="label" class="control-label">{$_L['Question']} <span class="red">*</span> </label>
								<input type="hidden" name="question" value="{if isset($question)}{$question->question}{/if}">
								<textarea name="question_label" id="question_label" cols="20" rows="2" class="form-control">{if isset($question)}{$question->question}{/if}</textarea>
							</div>
						</div>

						<div class="col-md-12 hide" id="choices-container">
							<div class="form-group sortable-choices">
								<label for="label" class="control-label fixed">{$_L['module_forms_options']}:
									<div class="choices-control">
										<a class="btn btn-primary btn-sm add-new-choice"><i class="fa fa-plus"></i></a>
									</div>
								</label>
							</div>
						</div>

						<div class="col-md-12 hide" id="slider-opinion-scale">
							<div class="form-group">
								<div id="slider">
									<div id="custom-handle" class="ui-slider-handle"></div>
									<input type="hidden" name="opinion-scale" class="form-control"
										   value="{if isset($question) && $question->range_value}{$question->range_value}{/if}">
								</div>
							</div>
						</div>

						<div class="col-md-12">
							<div class="form-group">
								<label for="label" class="control-label">{$_L['Description']} </label>
								<textarea name="description" id="description" cols="20" rows="2"
										  class="form-control">{if isset($question)}{$question->description}{/if}</textarea>
							</div>
						</div>

						<div class="col-md-12">
							<div class="form-group">
								<label for="label" class="control-label">{$_L['module_forms_max_n_caracteres']} </label>
								<input type="text" id="max_characters" name="max_characters" class="form-control"
									   value="{if isset($question) && ($question->max_characters > 0)}{$question->max_characters}{/if}">
							</div>
						</div>

						<div class="col-md-12">
							<div class="form-group">
								<label for="webservice-field" class="control-label">{$_L['Webservice Field']} </label>
								<select id="webservice-field" name="webservice_field" class="form-control select2">
									{if isset($question) && isset($form) && !empty($question->webservice_field_id)}
										{foreach $webservices_fields as $wf}
											{if isset($question) && $wf->webservice_field_id == $question->webservice_field_id}
												{assign var="is_selected" value=true}
											{else}
												{assign var="is_selected" value=false}
											{/if}

											{if $wf->webservice_id == $form->webservice_id}
												<option value="{$wf->webservice_field_id}" {if $is_selected}selected="selected"{/if}>{$wf->label}</option>
											{/if}
										{/foreach}
									{else}
										<option value="">{$_L['Select a Webservice Field']}</option>
									{/if}
								</select>
							</div>
						</div>

						<div class="col-md-12">
							<div class="form-group">
								<label for="multi_selections" class="control-label">{$_L['Multiple Selection']} </label>
								<input type="checkbox" name="multi_selections" id="multi_selections"
									   {if isset($question) && $question->multi_selections}checked="checked"{/if} value="1">
							</div>
						</div>

						<div class="col-md-12">
							<div class="form-group">
								<label for="required" class="control-label">{$_L['module_forms_required']}? </label>
								<input type="checkbox" name="required" id="required" value="1"
									   {if isset($question) && $question->required}checked="checked"{/if}>
							</div>
						</div>

					</div>
				</div>

				<div class="col-md-8">
					<div class="form-group question-preview" id="question-preview">
						<label for="" class="control-label"></label>
					</div>

					<div class="form-group question-preview response-preview" id="response-preview">
					</div>
				</div>

			</div>
		</form>
	</div>

	<div class="modal-footer">
		<button type="button" class="btn btn-primary" id="btn-add-question">
			<i class="fa fa-check"></i> {$_L['Submit']}
		</button>
	</div>