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{{ config('plumbing.phone_display', '(555) 000-1234') }}
AI Receptionist Online — Instant Response

Request a Plumber
We'll Call You Back Fast

Fill out the form and our AI receptionist will call you within minutes to confirm your appointment, answer questions, and connect you with a licensed technician.

Licensed & Insured
Same-Day Available
4.9★ Rated
No Hidden Fees
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🤖

Powered by Synthflow AI — After submitting this form, our AI receptionist "{{ config('plumbing.agent_name', 'Alex') }}" will automatically call your number to confirm the booking, collect any extra details, and answer your questions — available 24/7.

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{{-- Validation errors --}} @if ($errors->any())
Please correct the following:
    @foreach ($errors->all() as $error)
  • {{ $error }}
    • @endforeach
@endif
📋

Service Request Form

Takes about 2 minutes — our AI handles the rest

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Contact
2
Service
3
Schedule
4
AI Call
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@csrf {{-- ── Section 1: Contact Info ──────────────────────── --}}
Your Contact Information
@error('first_name') {{ $message }} @enderror
@error('last_name') {{ $message }} @enderror
@error('phone') {{ $message }} @enderror Our AI receptionist will call this number
@error('email') {{ $message }} @enderror
{{-- ── Section 2: Property ──────────────────────────── --}}
Property Address
@error('address') {{ $message }} @enderror
@error('city') {{ $message }} @enderror
@error('zip_code') {{ $message }} @enderror
@error('property_type') {{ $message }} @enderror
{{-- ── Section 3: Service Type ───────────────────────── --}}
What Service Do You Need? *
@error('service_type') {{ $message }} @enderror
@php $services = [ ['value' => 'drain_cleaning', 'icon' => '🔩', 'label' => 'Drain Cleaning'], ['value' => 'water_heater', 'icon' => '🔥', 'label' => 'Water Heater'], ['value' => 'leak_repair', 'icon' => '💧', 'label' => 'Leak Repair'], ['value' => 'sewer_septic', 'icon' => '🚧', 'label' => 'Sewer / Septic'], ['value' => 'toilet_repair', 'icon' => '🚽', 'label' => 'Toilet Repair'], ['value' => 'fixture_install', 'icon' => '🛁', 'label' => 'Fixture Install'], ['value' => 'repiping', 'icon' => '🔧', 'label' => 'Repiping'], ['value' => 'gas_line', 'icon' => '⚡', 'label' => 'Gas Line'], ['value' => 'emergency', 'icon' => '🚨', 'label' => 'Emergency'], ['value' => 'hydro_jetting', 'icon' => '💦', 'label' => 'Hydro Jetting'], ['value' => 'inspection', 'icon' => '🔍', 'label' => 'Inspection'], ['value' => 'other', 'icon' => '❓', 'label' => 'Other'], ]; @endphp @foreach ($services as $svc) @endforeach
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Urgency & Preferred Schedule
@php $urgencies = [ ['value' => 'emergency', 'icon' => '🚨', 'label' => 'Emergency — Right Now', 'cls' => 'emergency'], ['value' => 'today', 'icon' => '⚡', 'label' => 'Today', 'cls' => ''], ['value' => 'this_week', 'icon' => '📅', 'label' => 'This Week', 'cls' => ''], ['value' => 'flexible', 'icon' => '🗓️', 'label' => 'Flexible', 'cls' => ''], ]; @endphp @foreach ($urgencies as $u) @endforeach
@error('urgency') {{ $message }} @enderror
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Describe the Issue
@error('description') {{ $message }} @enderror
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AI Receptionist Callback
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Your info is secure and never sold. By submitting you agree to be contacted by our AI receptionist.

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