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--- a +++ b/templates/form.html @@ -0,0 +1,153 @@ +<!DOCTYPE html> +<html> +<head> + <title>Health Assessment Form</title> + <style> + body { + font-family: Arial, sans-serif; + margin: 0; + padding: 0; + background-color: #f5f5f5; + } + + h1 { + text-align: center; + margin-top: 30px; + color: #333333; + } + + .container { + max-width: 800px; + margin: 0 auto; + padding: 20px; + background-color: #ffffff; + border-radius: 10px; + box-shadow: 0 0 10px rgba(0, 0, 0, 0.2); + } + + label { + display: block; + margin-bottom: 10px; + font-weight: bold; + color: #333333; + } + + input[type="number"], select { + padding: 8px; + border-radius: 5px; + border: 1px solid #cccccc; + width: 100%; + box-sizing: border-box; + font-size: 16px; + margin-bottom: 20px; + } + + input[type="submit"] { + background-color: #4CAF50; + color: white; + border: none; + padding: 12px 20px; + text-align: center; + text-decoration: none; + display: inline-block; + font-size: 16px; + border-radius: 5px; + cursor: pointer; + transition: background-color 0.3s ease; + } + + input[type="submit"]:hover { + background-color: #3e8e41; + } + </style> + <link rel="icon" type="image/x-icon" href="https://img.icons8.com/color-glass/48/lungs.png"> +</head> +<body> + <div class="container"> + <h1>Health Assessment Form</h1> + <form method="POST" action="{{ url_for('results') }}"> + + <!-- Add a label for the form title --> + <label for="form_title" class="sr-only">Health Assessment Form</label> + <input type="hidden" name="form_title" id="form_title" value="Health Assessment Form"> + + <label for="age">Age:</label> + <input type="number" name="age" id="age" min="0" max="100" required value="30"> + + <label for="gender">Gender:</label> + <select name="gender" id="gender" required> + <option value="" disabled>Select gender</option> + <option value="male" selected>Male</option> + <option value="female">Female</option> + </select> + + <p>On a scale from 1 (lowest) to 9 (highest), update the following:</p> + + <label for="air_pollution">Air Pollution:</label> + <input type="number" name="air_pollution" id="air_pollution" min="1" max="9" required value="1"> + + <label for="alcohol_use">Alcohol use:</label> + <input type="number" name="alcohol_use" id="alcohol_use" min="1" max="9" required value="1"> + + <label for="dust_allergy">Dust Allergy:</label> + <input type="number" name="dust_allergy" id="dust_allergy" min="1" max="9" required value="1"> + + <label for="occupational_hazards">Occupational Hazards:</label> + <input type="number" name="occupational_hazards" id="occupational_hazards" min="1" max="9" required value="1"> + + <label for="genetic_risk">Genetic Risk:</label> + <input type="number" name="genetic_risk" id="genetic_risk" min="1" max="9" required value="1"> + + <label for="chronic_lung_disease">Chronic Lung Disease:</label> + <input type="number" name="chronic_lung_disease" id="chronic_lung_disease" min="1" max="9" required value="1"> + + <label for="balanced_diet">Balanced Diet:</label> + <input type="number" name="balanced_diet" id="balanced_diet" min="1" max="9" required value="1"> + + <label for="obesity">Obesity:</label> + <input type="number" name="obesity" id="obesity" min="1" max="9" required value="1"> + + <label for="smoking">Smoking:</label> + <input type="number" name="smoking" id="smoking" min="1" max="9" required value="1"> + + <label for="passive_smoker">Passive Smoker:</label> + <input type="number" name="passive_smoker" id="passive_smoker" min="1" max="9" required value="1"> + + <label for="chest_pain">Chest Pain:</label> + <input type="number" name="chest_pain" id="chest_pain" min="1" max="9" required value="1"> + + <label for="coughing_blood">Coughing of Blood:</label> + <input type="number" name="coughing_blood" id="coughing_blood" min="1" max="9" required value="1"> + + <label for="fatigue">Fatigue:</label> + <input type="number" name="fatigue" id="fatigue" min="1" max="9" required value="1"> + + <label for="weight_loss">Weight Loss:</label> + <input type="number" name="weight_loss" id="weight_loss" min="1" max="9" required value="1"> + + <label for="shortness_of_breath">Shortness of Breath:</label> + <input type="number" name="shortness_of_breath" id="shortness_of_breath" min="1" max="9" required value="1"> + + <label for="wheezing">Wheezing:</label> + <input type="number" name="wheezing" id="wheezing" min="1" max="9" required value="1"> + + <label for="swallowing_difficulty">Swallowing Difficulty:</label> + <input type="number" name="swallowing_difficulty" id="swallowing_difficulty" min="1" max="9" required value="1"> + + <label for="clubbing">Clubbing of Finger Nails:</label> + <input type="number" name="clubbing" id="clubbing" min="1" max="9" required value="1"> + + <label for="frequent_cold">Frequent Cold:</label> + <input type="number" name="frequent_cold" id="frequent_cold" min="1" max="9" required value="1"> + + <label for="dry_cough">Dry Cough:</label> + <input type="number" name="dry_cough" id="dry_cough" min="1" max="9" required value="1"> + + <label for="snoring">Snoring:</label> + <input type="number" name="snoring" id="snoring" min="1" max="9" required value="1"> + + <input type="submit" value="Submit"> + </form> + </div> +</body> +</html>