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[% INCLUDE 'header.html', bodyclass = 'authpage', 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 class="segmented-control segmented-control--radio">
<input type="radio" name="reported" id="reported_yes" value="Yes"[% ' checked' IF reported == 'Yes' %]>
<label class="btn" for="reported_yes">[% loc('Reported before') %]</label>
<input type="radio" name="reported" id="reported_no" value="No"[% ' checked' IF reported == 'No' %]>
<label class="btn" for="reported_no">[% loc('First time') %]</label>
</p>
<p><input type="submit" class="btn btn--primary" name="submit" value="[% loc('Submit') %]"></p>
</form>
[% INCLUDE 'footer.html' %]
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