Advertisement
Not a member of Pastebin yet?
Sign Up,
it unlocks many cool features!
- <!DOCTYPE html>
- <html>
- <head>
- <title>>Cek Kesehatan_ Rizky Anugrah XI RPL 2</title>
- </head>
- <body>
- <p>Penyakit yang diderita :</p>
- <form>
- <p>Nama depan : <input type="text" name="fname"> </p>
- <p>Nama Belakang : <input type="text" name="lname"></p>
- <input type="checkbox" name="checkbox1">Darah Tinggi<br>
- <input type="checkbox" name="checkbox2">Asam Urat<br>
- <input type="checkbox" name="checkbox3">Maag<br>
- <p><input type="image" src="Gambar/submit.jpg" alt="submit" width="110" height="40"></p>
- </form>
- </body>
- </html>
Advertisement
Add Comment
Please, Sign In to add comment
Advertisement