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PhysicalHealthForm.php
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PhysicalHealthForm.php
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<?php
if(isset($_POST['submit'])){
header('location: ./Report.php');
}
?>
<head>
<meta name="viewport" content="width=device-width, initial-scale=1">
<style>
body {font-family: Arial, Helvetica, sans-serif;
width:40%;
margin:auto;
margin-top:5%;}
* {box-sizing: border-box;}
.options{
margin-left:20px;
}
input[type=submit]:hover {
background-color: #45a049;
}
#form-img{
max-width:20%;
margin:2%;
}
#form-head{
display:flex;
justify-content:flex-start;
align-items:center;
}
.container {
border-radius: 5px;
background-color: #f2f2f2;
padding: 20px;
clear: both;
}
.container input{
width: 100%;
clear: both;
}
</style>
</head>
<body>
<div id="form-head">
<img src="./assets/icon1.png" id="form-img"></img>
<h2 style="text-align: center; font-size:40px; color:#ff3256; margin:2%;">Physical Health Check</h2>
</div>
<div class="container">
<form method="post">
<div>
<label><b>Q1</b> How is your apetite?</label><br><br>
<label for="none">Low apetite</label>
<input type="radio" id="none" name="option1" value="5">
<label for="little">Normal apetite</label>
<input type="radio" id="little" name="option1" value="4">
<label for="some">High apetite</label>
<input type="radio" id="some" name="option1" value="3">
</div>
<br>
<div>
<label><b>Q2</b> How is your blood flow during menstruation?</label><br><br>
<label for="none">Low flow</label>
<input type="radio" id="none" name="option2" value="5">
<label for="little">Medium flow</label>
<input type="radio" id="little" name="option2" value="4">
<label for="some">High flow</label>
<input type="radio" id="some" name="option2" value="3">
</div>
<br>
<div>
<label><b>Q3</b> Is your menstrual cycle regular?</label><br><br>
<label for="none">Regular</label>
<input type="radio" id="none" name="option3" value="5">
<label for="little">Irregular</label>
<input type="radio" id="little" name="option3" value="4">
</div>
<br>
<div>
<label><b>Q4</b> Do you feel tired?</label><br><br>
<label for="none">Most of the time</label>
<input type="radio" id="none" name="option4" value="5">
<label for="little">Sometimes</label>
<input type="radio" id="little" name="option4" value="4">
<label for="some">None of the time</label>
<input type="radio" id="some" name="option4" value="3">
</div>
<br>
<div>
<label><b>Q5</b> Did your weight change?</label><br><br>
<label for="none">Weight loss</label>
<input type="radio" id="none" name="option5" value="5">
<label for="little">Normal Weight</label>
<input type="radio" id="little" name="option5" value="4">
<label for="some">Weight Gain</label>
<input type="radio" id="some" name="option5" value="3">
</div>
<br>
<div>
<label><b>Q6</b> Do you experience mood swings?</label><br><br>
<label for="none">None of the time</label>
<input type="radio" id="none" name="option6" value="5">
<label for="little">Some of the time</label>
<input type="radio" id="little" name="option6" value="4">
<label for="most">Most of the time</label>
<input type="radio" id="most" name="option6" value="2">
</div>
<br>
<div>
<label><b>Q7</b> Did your sleep schedule change?</label><br><br>
<label for="none">Increase in sleeping hours</label>
<input type="radio" id="none" name="option7" value="5">
<label for="little">Normal sleeping hours</label>
<input type="radio" id="little" name="option7" value="4">
<label for="some">Decrease in sleeping hours</label>
<input type="radio" id="some" name="option7" value="3">
</div>
<br>
<div>
<label><b>Q8</b> Do you experience body ache?</label><br><br>
<label for="none">None of the time</label>
<input type="radio" id="none" name="option8" value="5">
<label for="some">Some of the time</label>
<input type="radio" id="some" name="option8" value="3">
<label for="all">All of the time</label>
<input type="radio" id="all" name="option8" value="1">
</div>
<br>
<input type="submit" name="submit" style="background-color:#ff3256;">
</form>
</div>
</body>
</html>