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<!DOCTYPE html>
<html lang="en">
<link href="https://fonts.googleapis.com/css?family=Lobster" rel="stylesheet" type="text/css">
<main class="form">
<CENTER>
<H1>
COVID-19 Self Assessment Survey
</H1>
<HR>
<FORM action=covidsurvey.php method=post>
<fieldset>
<label id ="name-label" for="name">Name:
<input type="text" placeholder="Enter Your Name" id ="name" name="name" required>
</label><br/>
<p>
<div>
<label for="Gender">Gender:</label>
<pstyle="padding-right: 5px;">
<br>
<pre class="tab">
<input type="radio" name="gender" value="Male" checked> Male<br>
<input type="radio" name="gender" value="Female"> Female
</pre> </p>
</div>
<label id ="number-label" for="Age">Age:
<input type="number" placeholder="INSERT" id="number" name="Age" required min="1" max="110" class="age" >
</label><br/>
<H2>
Do you have any of the following symptoms?
</H2>
<div style="width: 25%; margin-left: auto; margin-right: auto;">
<ul>
<p><li>Fever</p>
<p><li>Sore Throat</p>
<p><li>New Cough</p>
<p><li>New Shortness of Breath</p>
<p><li>New Muscle Aches</p>
<p><li>Unexplained loss of taste or smell</p>
<p><li>Dirrhea</p>
<p><li>Headache</p>
</ul>
</div>
<div>
<label for="covid"></label>
<input type="radio" name="covid" value="Yes" checked> YES
<input type="radio" name="covid" value="No"> NO
<input type="radio" name="covid" value="idk" style="display:none;">
</div>
<p>
<INPUT type=submit value="Submit Form">
<INPUT type=reset value="Reset Form">
</fieldset>
</FORM>
</CENTER>
</html>