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  • Form Kru

    Uploaded by

    Anmol Sharma
    6 views1 page
    The document contains a form asking the user to provide personal details like name, gender, phone number, address and email. It also asks the user to select vaccines taken from options like COVID-19, flu, hepatitis B, HPV and others. The form contains fields for first name, middle name, last name, gender, phone number with country code, address, email and vaccine details with radio buttons to select multiple options. It ends with a submit button to submit the filled form.

    Original Description:

    xyz

    Original Title

    form_kru

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    © © All Rights Reserved

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    The document contains a form asking the user to provide personal details like name, gender, phone number, address and email. It also asks the user to select vaccines taken from options like COVID-19, flu, hepatitis B, HPV and others. The form contains fields for first name, middle name, last name, gender, phone number with country code, address, email and vaccine details with radio buttons to select multiple options. It ends with a submit button to submit the filled form.

    Copyright:

    © All Rights Reserved
    Download as TXT, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as txt, pdf, or txt
    6 views1 page

    Form Kru

    Uploaded by

    Anmol Sharma
    The document contains a form asking the user to provide personal details like name, gender, phone number, address and email. It also asks the user to select vaccines taken from options like COVID-19, flu, hepatitis B, HPV and others. The form contains fields for first name, middle name, last name, gender, phone number with country code, address, email and vaccine details with radio buttons to select multiple options. It ends with a submit button to submit the filled form.

    Copyright:

    © All Rights Reserved
    Download as TXT, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as txt, pdf, or txt
    of 1

    <Html>

    <head>
    <title>
    FORM
    </title>
    </head>
    <body bgcolor="Lightskyblue">
    <h1>Fill up the following details.</h1
    <br>
    <form>
    <label> Firstname </label>
    <input type="text" name="Firstname" size="15" placeholder="abc"/> <br>
    <label> Middlename: </label>
    <input type="text" name="Middlename" size="15" placeholder="pqr"/> <br>
    <label> Lastname: </label>
    <input type="text" name="Lastname" size="15" placeholder="xyz"/> <br>
    <label>
    Gender :
    </label><br>
    <input type="radio" name="male"/> Male <br>
    <input type="radio" name="female"/> Female <br>
    <input type="radio" name="other"/> Other
    <br>
    <label>
    Phone :
    </label>
    <input type="text" name="country code" placeholder="+91" size="2"/>
    <input type="text" name="phone" size="10" placeholder="9875******"/> <br>
    Address
    <br>
    <textarea cols="80" rows="5" value="address" placeholder="Your address">
    </textarea>
    <br>
    Email:
    <input type="email" id="email" name="email" placeholder="xyz@gmail.com"/> <br>
    Select the vaccines that you've taken.
    </label><br>
    <input type="radio" name="COVID-19"/>COVID-19 <br>
    <input type="radio" name="Flu (influenza)"/>Flu (influenza) <br>
    <input type="radio" name="Hepatitis B"/>Hepatitis<br>
    <input type="radio" name="Human Papillomavirus (HPV)"/>Human Papillomavirus
    (HPV)<br>
    <input type="radio" name="Pneumococcal vaccine"/>Pneumococcal vaccine<br>
    <input type="radio" name="Shingles"/>Shingles<br>
    <input type="radio" name="Tetanus, Diphtheria, Pertusis (TDP)"/>Tetanus,
    Diphtheria, Pertusis (TDP)<br> <br>
    <input type="button" value="Submit"/>
    </form>
    </body>
    </html>

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