forked from WEB-IMB-WS2526/lab-development-imb
37 lines
1.5 KiB
HTML
37 lines
1.5 KiB
HTML
<!DOcTYPE html>
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<html lang="de">
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<head>
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<meta charset="utf-8" method="POST">
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<title>Anamesebogen</title>
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</head>
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<body>
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<h1>Anamesebogen</h1>
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<h2>Bitte ausfüllen</h2>
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<form>
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<fieldset>
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<legend>Persönliches</legend>
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<label for="name">Name:</label>
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<input type="text" name="name" id="name" required><br><br>
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<label for="vorname">Vorname:</label>
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<input type="text" name="vorname" id="vorname" required><br><br>
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<label for="gebdatum">Geburtsdatum</label>
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<input type="date" name="gebdatum" id="gebdatum" required><br><br>
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<label for="gender">Geschlecht</label>
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<select name="gender" id="gender" required><br><br>
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<option value="Weiblich">weiblich</option>
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<option value="männlich">männlich</option>
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<option value="divers">divers</option>
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<option value="ka">keine Angabe</option>
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</select>
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</fieldset>
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<fieldset>
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<legend>Körperdaten</legend>
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<label for="gewicht">Gewicht (kg):</label>
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<input type="number" name="gewicht" id="gewicht"><br><br>
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<label for="groesse">Größe (cm):</label>
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<input type="number" name="groesse" id="groesse"><br><br>
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</fieldset>
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<button type="submit">Absenden</button>
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</form>
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</body>
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</html> |