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<!DOCTYPE html> <html> <script language="javascript"> function doSubmit() { if( document.form1.q1.value == "" ) { alert("��س����͡�ӵͺ��ͷ�� 1") document.form1.q1.focus() return false; } if( document.form1.q2.value == "" ) { alert("��س����͡�ӵͺ��ͷ��2") document.form1.q2.focus() return false; } if( document.form1.q3.value == "" ) { alert("��س����͡�ӵͺ��ͷ��3") document.form1.q3.focus() return false; } if( document.form1.q4.value == "" ) { alert("��س����͡�ӵͺ��ͷ��4") document.form1.q4.focus() return false; } } </script> <head> <title>Ẻ�ͺ��������آ�Ҿ�Ե Depression Anxiety Stress Scales (DASS-21)</title> <link href="https://fonts.googleapis.com/css2?family=Trirong:wght@500&display=swap" rel="stylesheet"> <!--<link href="https://fonts.googleapis.com/css?family=chonburi:300,400,500,700" rel="stylesheet">--> <link rel="stylesheet" href="https://use.fontawesome.com/releases/v5.4.1/css/all.css" integrity="sha384-5sAR7xN1Nv6T6+dT2mhtzEpVJvfS3NScPQTrOxhwjIuvcA67KV2R5Jz6kr4abQsz" crossorigin="anonymous"> <style> html, body { height: 100%; } body, h1, h3, input, h2 { padding: 0; margin: 0; outline: none; font-family: Trirong, Roboto, Arial, sans-serif; font-size: 16px; color: #666; } h1, h3, h2 { padding: 12px 0; font-weight: 400; } h1 { font-size: 28px; } h2 { font-size: 16px; margin: 25; } .main-block, .info { display: flex; flex-direction: column; } .main-block { justify-content: center; align-items: center; width: 100%; min-height: 100%; background: url("/uploads/media/default/0001/01/49bff73f282c2c21f3341f1fe457fe35337b1792.jpeg") no-repeat center; background-size: cover; } form { width: 86%; padding: 20px; margin-bottom: 20px; border-radius: 5px; border: solid 1px #ccc; box-shadow: 1px 2px 5px rgba(0,0,0,.31); background: #ebebeb; } .info-item { width: 100%; } input { width: calc(100% - 57px); height: 36px; padding-left: 10px; margin: 0 0 12px -5px; border-radius: 0 5px 5px 0; border: solid 1px #cbc9c9; box-shadow: 1px 2px 5px rgba(0,0,0,.09); background: #fff; } .icon { padding: 9px 15px; margin-top: -1px; border-radius: 5px 0 0 5px; border: solid 0px #cbc9c9; background: #666; color: #fff; } textarea { width: 99%; margin-bottom: 12px; } button { width: 100%; padding: 8px; border-radius: 5px; border: none; background: #8ebf42; font-size: 14px; font-weight: 600; color: #fff; } button:hover { background: #82b534; } .grade-type div { display: flex; margin: 6px 0; } @media (min-width: 568px) { .info { flex-flow: row wrap; justify-content: space-between; } .info-item { width: 48%; } } </style> </head> <body> <div class="main-block"> <h1>Ẻ�ͺ��������آ�Ҿ�Ե Depression <br>Anxiety Stress Scales (DASS-21)</h1> <h2>��س���ҹ��ͤ�������Т�ʹ�ҹ��ҧ��� ����к���Ң�ͤ����ѧ����ǵç�Ѻ��Ƿ�ҹ�ҡ������§� 㹪�ǧ�ѻ�������ҹ�� <br>��駹��ӵͺ����ն١�Դ��С�س��������������Т�ҹ�Թ� <br> ࡳ���û����Թ�մѧ���<br> 0 ���ç�Ѻ�ѹ���<br> 1 �ç�Ѻ�ѹ��ҧ �����Դ����繺ҧ����<br> 2 �ç�Ѻ�ѹ �����Դ��鹺���<br> 3 �ç�Ѻ�ѹ�� �����Դ��鹺����ҡ����ش </h2> <form action="save.asp" name="form1" method="post"> <div class="info"> <div class="info-item"> <label class="icon" for="name"><i class="fas fa-user"></i></label> <input type="text" name="name" id="name" placeholder="��سҡ�͡�������" required/> </div> <!-- <div class="info-item"> <label class="icon" for="age"><i class="fas fa-calendar"></i></i></label> <input type="text" name="age" id="age" placeholder="Age" required/> </div> <div class="info-item"> <label class="icon" for="email"><i class="fas fa-envelope"></i></label> <input type="text" name="email" id="email" placeholder="Email" required/> </div> <div class="info-item"> <label class="icon" for="phone"><i class="fas fa-phone"></i></label> <input type="text" name="phone" id="phone" placeholder="Phone" required/> </div>--> </div> <!-- <div class="grade-type">--> <h3>1. �ѹ����֡�ҡ����ʧ��Ե�ŧ </h3> <div> <!--<input type="radio" value="0" id="radioOne" name="grade" checked/>--> <input type="radio" value="0" id="radioOne" name="q1"/> <label for="radioOne" class="radio">����ͧ�Ѻ�ѹ���</label> </div> <div> <input type="radio" value="1" id="radioTwo" name="q1"/> <label for="radioTwo" class="radio">�ç�Ѻ�ѹ��ҧ �����Դ����繺ҧ����</label> </div> <div> <input type="radio" value="2" id="radioThree" name="q1" required/> <label for="radioThree" class="radio">�ç�Ѻ�ѹ �����Դ��鹺���</label> </div> <div> <input type="radio" value="3" id="radioFour" name="q1"/> <label for="radioFour" class="radio">�ç�Ѻ�ѹ�� �����Դ��鹺����ҡ����ش</label> </div> <h3>2. �ѹ����֡�ҡ��駤���� </h3> <div> <!--<input type="radio" value="0" id="radioOne" name="grade" checked/>--> <input type="radio" value="0" id="radioOne" name="q2"/> <label for="radioOne" class="radio">����ͧ�Ѻ�ѹ���</label> </div> <div> <input type="radio" value="1" id="radioTwo" name="q2"/> <label for="radioTwo" class="radio">�ç�Ѻ�ѹ��ҧ �����Դ����繺ҧ����</label> </div> <div> <input type="radio" value="2" id="radioThree" name="q2" required/> <label for="radioThree" class="radio">�ç�Ѻ�ѹ �����Դ��鹺���</label> </div> <div> <input type="radio" value="3" id="radioFour" name="q2"/> <label for="radioFour" class="radio">�ç�Ѻ�ѹ�� �����Դ��鹺����ҡ����ش</label> </div> <!-- </div>--> <!-- <h3>Please Comment on Your Rating</h3> <textarea rows="4"></textarea>--> <div> <label for="name">Name</label> <input type="text" name="name" id="name" /> </div> <div> <label for="email">Email</label> <input type="email" name="email" id="email" required /> </div> <div> <input type="radio" name="radio-choice" id="radio-choice-1" value="choice-1" required /> <label for="radio-choice-1">Choice 1</label> <input type="radio" name="radio-choice" id="radio-choice-2" value="choice-2" required /> <button type="submit" href="save.asp">�ټš�û����Թ</button> </form> </div> </body> </html>