Design the intake form

[calexity]

Design the intake form using bootstrap or a similar set of UI components.

Notes

1. Form needs to include everything listed in the IA up to Profile:
   https://github.com/hackforla/heart/wiki/Information-Architecture
   Should match the paper form.

2. Put the clinic attended at the top as two fields
   Location and Date (where date autopopulates but is editable)
   Design intent is for this to save for every user until changed and saved

3. CTA to submit form is "Save and Complete"

4. Add the checkboxes for all the agreements (we'll hold on signature for now)

5. Include email, phone OR mailing address as a way to get notified about status (with the agreement)

6. When form submits successfully, should say "firstName lastName intake saved" as a toast on top of a new blank form.

7. If form is not saved successfully, show "Intake not saved. Please retry." AND keep them on the form with all the info filled in

8. Form should cache info so a page refresh doesn't clear it out. Only clear on submit.

9. If any of the required fields are not filled in, kick them up to the first unfilled field and show the error near the field