Untitled

<!DOCTYPE html>
<html>
<head>
    <title>Cek Kesehatan</title>
</head>
<body>
<form>
    <p> Nama Depan    : <input type="textarea" name="fnama"></p>
    <p> Nama Belakang : <input type="textarea" name="lnama"></p>
    <input type="checkbox" name="checkbox1">Asam Urat</input><br>
    <input type="checkbox" name="checkbox2">Darah Tnggi</input><br>
    <input type="checkbox" name="checkbox3">Maag</input><br>
    <p><input type="image" src="audio/TN.JPG" alt="submit"></p>
</form>
</body>
</html>