{{ csrf() }}
<select name="reason">
  <option value="spam">{{ _('Spam or other unrelated content') }}</option>
  <option value="language">{{ _('Inappropriate language/dialog') }}</option>
  <option value="bug_support">{{ _('Misplaced bug report or support request') }}</option>
  <option value="other">{{ _('Other (please specify)') }}</option>
</select>
<input type="text" class="text" name="other" />
<input type="submit" class="link-btn" value="{{ _('Report Abuse') }}" />