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RizkyAnugrah

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Sep 11th, 2019
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  1. <!DOCTYPE html>
  2. <html>
  3.  
  4. <head>
  5.     <title>>Cek Kesehatan_ Rizky Anugrah XI RPL 2</title>
  6. </head>
  7.  
  8. <body>
  9.     <p>Penyakit yang diderita :</p>
  10.     <form>
  11.         <p>Nama depan : <input type="text" name="fname"> </p>
  12.         <p>Nama Belakang : <input type="text" name="lname"></p>
  13.         <input type="checkbox" name="checkbox1">Darah Tinggi<br>
  14.         <input type="checkbox" name="checkbox2">Asam Urat<br>
  15.         <input type="checkbox" name="checkbox3">Maag<br>
  16.         <p><input type="image" src="Gambar/submit.jpg" alt="submit" width="110" height="40"></p>
  17.     </form>
  18.  
  19. </body>
  20.  
  21. </html>
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