[% INCLUDE 'header.html', title = loc('Confirmation') %]

<form method="post" action="/questionnaire/submit" id="questionnaire">
<input type="hidden" name="problem" value="[% problem_id | html %]">

[% INCLUDE 'errors.html' %]

<p>
[% loc("Thanks, glad to hear it's been fixed! Could we just ask if you have ever reported a problem to a council before?") %]
</p>

<p align="center">
<input type="radio" name="reported" id="reported_yes" value="Yes"[% ' checked' IF reported == 'Yes' %]>
<label class="inline" for="reported_yes">[% loc('Yes') %]</label>
<input type="radio" name="reported" id="reported_no" value="No"[% ' checked' IF reported == 'No' %]>
<label class="inline" for="reported_no">[% loc('No') %]</label>
</p>

<p><input type="submit" name="submit" value="[% loc('Submit') %]"></p>

</form>

[% INCLUDE 'footer.html' %]