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Models:
Richard Zick
RichardZick/
lung-cancer-risk-pred
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a b/templates/form.html 

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<!DOCTYPE html>





  
  

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<html>





  
  

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<head>





  
  

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    <title>Health Assessment Form</title>





  
  

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    <style>





  
  

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        body {





  
  

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            font-family: Arial, sans-serif;





  
  

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            margin: 0;





  
  

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            padding: 0;





  
  

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            background-color: #f5f5f5;





  
  

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        }





  
  

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        h1 {





  
  

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            text-align: center;





  
  

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            margin-top: 30px;





  
  

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            color: #333333;





  
  

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        }





  
  

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        .container {





  
  

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            max-width: 800px;





  
  

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            margin: 0 auto;





  
  

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            padding: 20px;





  
  

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            background-color: #ffffff;





  
  

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            border-radius: 10px;





  
  

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            box-shadow: 0 0 10px rgba(0, 0, 0, 0.2);





  
  

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        }





  
  

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        label {





  
  

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            display: block;





  
  

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            margin-bottom: 10px;





  
  

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            font-weight: bold;





  
  

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            color: #333333;





  
  

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        }





  
  

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        input[type="number"], select {





  
  

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            padding: 8px;





  
  

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            border-radius: 5px;





  
  

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            border: 1px solid #cccccc;





  
  

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            width: 100%;





  
  

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            box-sizing: border-box;





  
  

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            font-size: 16px;





  
  

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            margin-bottom: 20px;





  
  

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        }





  
  

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        input[type="submit"] {





  
  

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            background-color: #4CAF50;





  
  

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            color: white;





  
  

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            border: none;





  
  

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            padding: 12px 20px;





  
  

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            text-align: center;





  
  

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            text-decoration: none;





  
  

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            display: inline-block;





  
  

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            font-size: 16px;





  
  

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            border-radius: 5px;





  
  

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            cursor: pointer;





  
  

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            transition: background-color 0.3s ease;





  
  

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        }





  
  

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        input[type="submit"]:hover {





  
  

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            background-color: #3e8e41;





  
  

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        }





  
  

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    </style>





  
  

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    <link rel="icon" type="image/x-icon" href="https://img.icons8.com/color-glass/48/lungs.png">





  
  

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</head>





  
  

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<body>





  
  

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    <div class="container">





  
  

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        <h1>Health Assessment Form</h1>





  
  

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        <form method="POST" action="{{ url_for('results') }}">





  
  

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            <!-- Add a label for the form title -->





  
  

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            <label for="form_title" class="sr-only">Health Assessment Form</label>





  
  

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            <input type="hidden" name="form_title" id="form_title" value="Health Assessment Form">





  
  

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            <label for="age">Age:</label>





  
  

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            <input type="number" name="age" id="age" min="0" max="100" required value="30">





  
  

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            <label for="gender">Gender:</label>





  
  

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            <select name="gender" id="gender" required>





  
  

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                <option value="" disabled>Select gender</option>





  
  

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                <option value="male" selected>Male</option>





  
  

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                <option value="female">Female</option>





  
  

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            </select>





  
  

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            <p>On a scale from 1 (lowest) to 9 (highest), update the following:</p>





  
  

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            <label for="air_pollution">Air Pollution:</label>





  
  

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            <input type="number" name="air_pollution" id="air_pollution" min="1" max="9" required value="1">





  
  

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            <label for="alcohol_use">Alcohol use:</label>





  
  

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            <input type="number" name="alcohol_use" id="alcohol_use" min="1" max="9" required value="1">





  
  

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            <label for="dust_allergy">Dust Allergy:</label>





  
  

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            <input type="number" name="dust_allergy" id="dust_allergy" min="1" max="9" required value="1">





  
  

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            <label for="occupational_hazards">Occupational Hazards:</label>





  
  

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            <input type="number" name="occupational_hazards" id="occupational_hazards" min="1" max="9" required value="1">





  
  

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            <label for="genetic_risk">Genetic Risk:</label>





  
  

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            <input type="number" name="genetic_risk" id="genetic_risk" min="1" max="9" required value="1">





  
  

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            <label for="chronic_lung_disease">Chronic Lung Disease:</label>





  
  

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            <input type="number" name="chronic_lung_disease" id="chronic_lung_disease" min="1" max="9" required value="1">





  
  

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            <label for="balanced_diet">Balanced Diet:</label>





  
  

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            <input type="number" name="balanced_diet" id="balanced_diet" min="1" max="9" required value="1">





  
  

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            <label for="obesity">Obesity:</label>





  
  

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            <input type="number" name="obesity" id="obesity" min="1" max="9" required value="1">





  
  

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            <label for="smoking">Smoking:</label>





  
  

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            <input type="number" name="smoking" id="smoking" min="1" max="9" required value="1">





  
  

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            <label for="passive_smoker">Passive Smoker:</label>





  
  

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            <input type="number" name="passive_smoker" id="passive_smoker" min="1" max="9" required value="1">





  
  

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            <label for="chest_pain">Chest Pain:</label>





  
  

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            <input type="number" name="chest_pain" id="chest_pain" min="1" max="9" required value="1">





  
  

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            <label for="coughing_blood">Coughing of Blood:</label>





  
  

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            <input type="number" name="coughing_blood" id="coughing_blood" min="1" max="9" required value="1">





  
  

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            <label for="fatigue">Fatigue:</label>





  
  

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            <input type="number" name="fatigue" id="fatigue" min="1" max="9" required value="1">





  
  

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            <label for="weight_loss">Weight Loss:</label>





  
  

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            <input type="number" name="weight_loss" id="weight_loss" min="1" max="9" required value="1">





  
  

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            <label for="shortness_of_breath">Shortness of Breath:</label>





  
  

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            <input type="number" name="shortness_of_breath" id="shortness_of_breath" min="1" max="9" required value="1">





  
  

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            <label for="wheezing">Wheezing:</label>





  
  

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            <input type="number" name="wheezing" id="wheezing" min="1" max="9" required value="1">





  
  

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            <label for="swallowing_difficulty">Swallowing Difficulty:</label>





  
  

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            <input type="number" name="swallowing_difficulty" id="swallowing_difficulty" min="1" max="9" required value="1">





  
  

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            <label for="clubbing">Clubbing of Finger Nails:</label>





  
  

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            <input type="number" name="clubbing" id="clubbing" min="1" max="9" required value="1">





  
  

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            <label for="frequent_cold">Frequent Cold:</label>





  
  

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            <input type="number" name="frequent_cold" id="frequent_cold" min="1" max="9" required value="1">





  
  

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            <label for="dry_cough">Dry Cough:</label>





  
  

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            <input type="number" name="dry_cough" id="dry_cough" min="1" max="9" required value="1">





  
  

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            <label for="snoring">Snoring:</label>





  
  

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            <input type="number" name="snoring" id="snoring" min="1" max="9" required value="1">





  
  

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            <input type="submit" value="Submit">





  
  

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        </form>





  
  

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    </div>





  
  

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</body>





  
  

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</html>