function MainComponent() { return /*#__PURE__*/ React.createElement("div", { className: "min-h-screen bg-[#F4F6F8] flex flex-col items-center justify-center", __source: { fileName: "", lineNumber: 3, columnNumber: 5 }, __self: this }, /*#__PURE__*/ React.createElement("div", { className: "bg-white shadow-lg rounded-lg p-8 max-w-lg w-full", __source: { fileName: "", lineNumber: 4, columnNumber: 7 }, __self: this }, /*#__PURE__*/ React.createElement("h1", { className: "text-2xl font-bold text-[#333] mb-6", __source: { fileName: "", lineNumber: 5, columnNumber: 9 }, __self: this }, "Spine Pain Survey"), /*#__PURE__*/ React.createElement("form", { __source: { fileName: "", lineNumber: 6, columnNumber: 9 }, __self: this }, /*#__PURE__*/ React.createElement("div", { className: "mb-4", __source: { fileName: "", lineNumber: 7, columnNumber: 11 }, __self: this }, /*#__PURE__*/ React.createElement("label", { className: "block text-sm font-semibold text-[#555]", htmlFor: "age", __source: { fileName: "", lineNumber: 8, columnNumber: 13 }, __self: this }, "Age"), /*#__PURE__*/ React.createElement("input", { type: "number", name: "age", className: "mt-1 p-2 w-full border rounded", required: true, __source: { fileName: "", lineNumber: 9, columnNumber: 13 }, __self: this })), /*#__PURE__*/ React.createElement("div", { className: "mb-4", __source: { fileName: "", lineNumber: 11, columnNumber: 11 }, __self: this }, /*#__PURE__*/ React.createElement("label", { className: "block text-sm font-semibold text-[#555]", htmlFor: "gender", __source: { fileName: "", lineNumber: 12, columnNumber: 13 }, __self: this }, "Gender"), /*#__PURE__*/ React.createElement("select", { name: "gender", className: "mt-1 p-2 w-full border rounded", __source: { fileName: "", lineNumber: 13, columnNumber: 13 }, __self: this }, /*#__PURE__*/ React.createElement("option", { value: "", __source: { fileName: "", lineNumber: 14, columnNumber: 15 }, __self: this }, "Select..."), /*#__PURE__*/ React.createElement("option", { value: "male", __source: { fileName: "", lineNumber: 15, columnNumber: 15 }, __self: this }, "Male"), /*#__PURE__*/ React.createElement("option", { value: "female", __source: { fileName: "", lineNumber: 16, columnNumber: 15 }, __self: this }, "Female"), /*#__PURE__*/ React.createElement("option", { value: "other", __source: { fileName: "", lineNumber: 17, columnNumber: 15 }, __self: this }, "Other"))), /*#__PURE__*/ React.createElement("div", { className: "mb-4", __source: { fileName: "", lineNumber: 20, columnNumber: 11 }, __self: this }, /*#__PURE__*/ React.createElement("label", { className: "block text-sm font-semibold text-[#555]", htmlFor: "painDuration", __source: { fileName: "", lineNumber: 21, columnNumber: 13 }, __self: this }, "Pain Duration"), /*#__PURE__*/ React.createElement("select", { name: "painDuration", className: "mt-1 p-2 w-full border rounded", __source: { fileName: "", lineNumber: 22, columnNumber: 13 }, __self: this }, /*#__PURE__*/ React.createElement("option", { value: "", __source: { fileName: "", lineNumber: 23, columnNumber: 15 }, __self: this }, "Select..."), /*#__PURE__*/ React.createElement("option", { value: "less_than_a_week", __source: { fileName: "", lineNumber: 24, columnNumber: 15 }, __self: this }, "Less than a week"), /*#__PURE__*/ React.createElement("option", { value: "one_to_four_weeks", __source: { fileName: "", lineNumber: 25, columnNumber: 15 }, __self: this }, "1-4 weeks"), /*#__PURE__*/ React.createElement("option", { value: "one_to_three_months", __source: { fileName: "", lineNumber: 26, columnNumber: 15 }, __self: this }, "1-3 months"), /*#__PURE__*/ React.createElement("option", { value: "over_three_months", __source: { fileName: "", lineNumber: 27, columnNumber: 15 }, __self: this }, "Over 3 months"))), /*#__PURE__*/ React.createElement("div", { className: "mb-4", __source: { fileName: "", lineNumber: 30, columnNumber: 11 }, __self: this }, /*#__PURE__*/ React.createElement("label", { className: "block text-sm font-semibold text-[#555]", htmlFor: "painLevel", __source: { fileName: "", lineNumber: 31, columnNumber: 13 }, __self: this }, "Pain Level"), /*#__PURE__*/ React.createElement("select", { name: "painLevel", className: "mt-1 p-2 w-full border rounded", __source: { fileName: "", lineNumber: 32, columnNumber: 13 }, __self: this }, /*#__PURE__*/ React.createElement("option", { value: "", __source: { fileName: "", lineNumber: 33, columnNumber: 15 }, __self: this }, "Select..."), /*#__PURE__*/ React.createElement("option", { value: "mild", __source: { fileName: "", lineNumber: 34, columnNumber: 15 }, __self: this }, "Mild"), /*#__PURE__*/ React.createElement("option", { value: "moderate", __source: { fileName: "", lineNumber: 35, columnNumber: 15 }, __self: this }, "Moderate"), /*#__PURE__*/ React.createElement("option", { value: "severe", __source: { fileName: "", lineNumber: 36, columnNumber: 15 }, __self: this }, "Severe"))), /*#__PURE__*/ React.createElement("div", { className: "mb-4", __source: { fileName: "", lineNumber: 39, columnNumber: 11 }, __self: this }, /*#__PURE__*/ React.createElement("label", { className: "block text-sm font-semibold text-[#555]", htmlFor: "additionalComments", __source: { fileName: "", lineNumber: 40, columnNumber: 13 }, __self: this }, "Additional Comments"), /*#__PURE__*/ React.createElement("textarea", { name: "additionalComments", className: "mt-1 p-2 w-full border rounded h-[100px]", __source: { fileName: "", lineNumber: 41, columnNumber: 13 }, __self: this })), /*#__PURE__*/ React.createElement("button", { type: "submit", className: "w-full bg-[#4CAF50] text-white font-semibold p-2 rounded hover:bg-[#43A047] transition duration-200", __source: { fileName: "", lineNumber: 43, columnNumber: 11 }, __self: this }, "Submit Survey")))); }