mirror of
https://gitlab.winehq.org/wine/wine-gecko.git
synced 2024-09-13 09:24:08 -07:00
56 lines
1.6 KiB
HTML
56 lines
1.6 KiB
HTML
|
|
<html>
|
|
<head>
|
|
<title> test filedset001.html</title>
|
|
</head>
|
|
<body>
|
|
fieldset and legend, sample from<br>
|
|
http://www.w3.org/TR/WD-html40/interact/forms.html#edef-FIELDSET
|
|
<br>Text after form
|
|
|
|
<FORM action="..." method="post">
|
|
<FIELDSET>
|
|
<LEGEND align="top">Personal Information</LEGEND>
|
|
Last Name: <INPUT name="personal_lastname" type="text" tabindex="1">
|
|
First Name: <INPUT name="personal_firstname" type="text" tabindex="2">
|
|
Address: <INPUT name="personal_address" type="text" tabindex="3">
|
|
...more personal information...
|
|
</FIELDSET>
|
|
<FIELDSET>
|
|
<LEGEND align="top">Medical History</LEGEND>
|
|
<INPUT name="history_illness"
|
|
type="checkbox"
|
|
value="Smallpox" tabindex="20"> Smallpox</INPUT>
|
|
<INPUT name="history_illness"
|
|
type="checkbox"
|
|
value="Mumps" tabindex="21"> Mumps</INPUT>
|
|
<INPUT name="history_illness"
|
|
type="checkbox"
|
|
value="Dizziness" tabindex="22"> Dizziness</INPUT>
|
|
<INPUT name="history_illness"
|
|
type="checkbox"
|
|
value="Sneezing" tabindex="23"> Sneezing</INPUT>
|
|
...more medical history...
|
|
</FIELDSET>
|
|
<FIELDSET>
|
|
<LEGEND align="top">Current Medication</LEGEND>
|
|
Are you currently taking any medication?
|
|
<INPUT name="medication_now"
|
|
type="radio"
|
|
value="Yes" tabindex="35">Yes</INPUT>
|
|
<INPUT name="medication_now"
|
|
type="radio"
|
|
value="No" tabindex="35">No</INPUT>
|
|
|
|
If you are currently taking medication, please indicate
|
|
it in the space below:
|
|
<TEXTAREA name="current_medication"
|
|
rows="20" cols="50"
|
|
tabindex="40">
|
|
</TEXTAREA>
|
|
</FIELDSET>
|
|
</FORM>
|
|
|
|
Text after form
|
|
</body>
|
|
</html> |