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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 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; 
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      .icon {
      padding: 9px 15px;
      margin-top: -1px;
      border-radius: 5px 0 0 5px;
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	  input[type=radio] {
      display: none;
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      label.radio {
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      text-indent: 32px;
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      label.radio:before {
      content: "";
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      left: 0;
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      border: 0.5px solid #8ebf42;
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      label.radio:after {
      content: "";
      position: absolute;
      width: 8px;
      height: 4px;
      top: 5px;
      left: 4px;
      border-bottom: 3px solid #8ebf42;
      border-left: 3px solid #8ebf42;
      transform: rotate(-45deg);
      opacity: 0;
      }
	  
      input[type=radio]:checked + label:after {
      opacity: 1;
	  
      }
      textarea {
      width: 99%;
      margin-bottom: 12px;
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      button {
      width: 100%;
      padding: 8px;
      border-radius: 5px; 
      border: none;
      background: #8ebf42; 
      font-size: 14px;
      font-weight: 600;
      color: #fff;
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      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>
        
          <h3>1. �ѹ����֡�ҡ����ʧ��Ե�ŧ  </h3>
          <div> 
            
			<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="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>
    <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>

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