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<center> <body bgcolor = "moccasin"> <font size = "7" color = "green"><b> Where are your symptoms occuring?</b> </font> <hr> <font size = "5"> <form action = acuDia2.php method = post> From the list Below, choose where your symptoms are occuring.<br><br> <input type = checkbox name = symptoms[] value = 1> The Head<br> <input type = checkbox name = symptoms[] value = 2> Local Pain<br> <input type = checkbox name = symptoms[] value = 3> Cold and Flu<br> <input type = checkbox name = symptoms[] value = 4> Nervous System<br> <input type = checkbox name = symptoms[] value = 5> Cardiovascular<br> <input type = checkbox name = symptoms[] value = 6> Abdominal Pain<br> <input type = checkbox name = symptoms[] value = 7> For Women<br> <input type = checkbox name = symptoms[] value = 8> Urinary Problems<br> <input type = checkbox name = symptoms[] value = 9> Other Problems<br><br> <p> <input type = submit value = "Submit" style="height:50px; width:80px"> <input type = reset value = "Reset" style="height:50px; width:80px"><br> </font> <p> <A HREF = acuMain.html style="color : black"> Main Page </a> </center>