Antuistiqra Jan 21st, 2020 65 Never
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  1. <!DOCTYPE html>
  2. <html>
  3. <head>
  4.     <title>Cek Kesehatan</title>
  5. </head>
  6. <body>
  7. <form>
  8.     <p> Nama Depan    : <input type="textarea" name="fnama"></p>
  9.     <p> Nama Belakang : <input type="textarea" name="lnama"></p>
  10.     <input type="checkbox" name="checkbox1">Asam Urat</input><br>
  11.     <input type="checkbox" name="checkbox2">Darah Tnggi</input><br>
  12.     <input type="checkbox" name="checkbox3">Maag</input><br>
  13.     <p><input type="image" src="audio/TN.JPG" alt="submit"></p>
  14. </form>
  15. </body>
  16. </html>
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