HTML_JS_CSS/simplesurveyform.html at master · uobinnao/HTML_JS_CSS · GitHub

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<!DOCTYPE html>
<html lang="en">
<head>
    <meta charset="UTF-8">
    <meta name="viewport" content="width=device-width, initial-scale=1.0">
    <title>Feedback Survey Form</title>
    <style>
        .center_text{
            text-align: center;
        }
    </style>
</head>
<body>
    <form action="process.php">
        <h1 class="center_text">Feedback Survey Form</h1>
        <label>
            First Name: <input type="text" name="First Name" >
        </label>
        <div></div>
        <label>
            Email:  <input type="email" name="Email" >
        </label>
        <div></div>
        <label>
            Age: <input type="number" name="Age" >
        </label>
        <div></div>
        <p>
            Type of Feedback
        </p>
        <select name="Feedback-type">
            <option value="Positive">Positive</option>
            <option value="Negitive">Negitive</option>
            <option value="Suggestion">Suggestion</option>
        </select>
        <p>Services Used:</p>
        <label>
            <input type="checkbox" name="Service1" > Service 1
        </label>
        <div></div>
        <label>
            <input type="checkbox" name="Service2" > Service 2
        </label>
        <div></div>
        <label>
            <input type="checkbox" name="Service3" > Service 3
        </label>
        <p>Additional Comments</p>
        <textarea name="AddComm/entsTextarea" id="AddCommentsTextarea" cols="50"></textarea>
        <div>
        <input type="submit" value="Submit Feedback">
        </div>

        <!-- <fieldset>
            <legend>Services Used:</legend>
            <label>
                <input type="checkbox" name="Service1" > Service 1
            </label>
            <label>
                <input type="checkbox" name="Service2" > Service 2
            </label>
            <label>
                <input type="checkbox" name="Service3" > Service 3
            </label>
            <input type="submit" value="Submit Feedback">
        </fieldset> -->
    </form>
</body>
</html>