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index.html
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<!DOCTYPE html>
<html lang="en">
<head>
<meta charset="UTF-8" />
<meta name="viewport" content="width=device-width, initial-scale=1.0" />
<title>Survey Form</title>
<!-- Bootstrap CSS -->
<link
href="https://cdn.jsdelivr.net/npm/[email protected]/dist/css/bootstrap.min.css"
rel="stylesheet"
/>
<!-- Font Awesome CDN -->
<link
href="https://cdnjs.cloudflare.com/ajax/libs/font-awesome/5.15.4/css/all.min.css"
rel="stylesheet"
/>
<link rel="stylesheet" href="styles.css">
</head>
<body>
<div class="container mt-5">
<form>
<div class="mb-3">
<label for="name" class="form-label"
><b>Name</b><span style="color: red">*</span></label
>
<div class="row">
<div class="col">
<input
type="text"
class="form-control form-control-sm"
id="first_name"
required
/>
<p>First</p>
</div>
<div class="col">
<input
type="text"
class="form-control form-control-sm"
id="last_name"
required
/>
<p>Last</p>
</div>
</div>
</div>
<div class="mb-3">
<label for="email" class="form-label"
><b>Email</b><span style="color: red">*</span></label
>
<input type="text" class="form-control" id="email" required />
</div>
<div class="mb-3">
<p><b>Your Experience</b><span style="color: red">*</span></p>
<div class="rating">
<input type="radio" id="star5" name="rating" value="5" />
<label for="star5">5 stars</label>
<input type="radio" id="star4" name="rating" value="4" />
<label for="star4">4 stars</label>
<input type="radio" id="star3" name="rating" value="3" />
<label for="star3">3 stars</label>
<input type="radio" id="star2" name="rating" value="2" />
<label for="star2">2 stars</label>
<input type="radio" id="star1" name="rating" value="1" />
<label for="star1">1 star</label>
</div>
</div>
<div class="mb-3">
<label></label>
</div>
<div class="mb-3">
<label>Overall, how would you rate your experience with us?</label>
</div>
<div class="mb-3">
<label
><b>How satisfied are you with</b
><span style="color: red">*</span></label
>
<table class="table table-responsive" style="width: 100%;">
<tr>
<td></td>
<td>Very Unsatisfied</td>
<td>Unsatisfied</td>
<td>Neutral</td>
<td>Satisfied</td>
<td>Very Satisfied</td>
</tr>
<tr class="grey-bg">
<td style="width: 16%; text-align: left;">Purchase</td>
<td><input type="radio" /></td>
<td><input type="radio" /></td>
<td><input type="radio" /></td>
<td><input type="radio" /></td>
<td><input type="radio" /></td>
</tr>
<tr>
<td style="width: 16%; text-align: left;">Service</td>
<td><input type="radio" /></td>
<td><input type="radio" /></td>
<td><input type="radio" /></td>
<td><input type="radio" /></td>
<td><input type="radio" /></td>
</tr>
<tr class="grey-bg">
<td style="width: 16%; text-align: left;">Company Overall</td>
<td><input type="radio" /></td>
<td><input type="radio" /></td>
<td><input type="radio" /></td>
<td><input type="radio" /></td>
<td><input type="radio" /></td>
</tr>
</table>
</div>
<div class="mb-3">
<label><b>How likely are you to</b><span style="color: red">*</span></label>
<table class="table table-responsive" style="width: 100%;">
<tr>
<td></td>
<td>Very Unlikely</td>
<td>Unlikely</td>
<td>Neutral</td>
<td>Likely</td>
<td>Very Likely</td>
</tr>
<tr class="grey-bg">
<td style="width: 15.5%; text-align: left;">Buy from us again</td>
<td><input type="radio" /></td>
<td><input type="radio" /></td>
<td><input type="radio" /></td>
<td><input type="radio" /></td>
<td><input type="radio" /></td>
</tr>
<tr>
<td style="width: 15.5%; text-align: left;">Recommend our <br>products to others</td>
<td><input type="radio" /></td>
<td><input type="radio" /></td>
<td><input type="radio" /></td>
<td><input type="radio" /></td>
<td><input type="radio" /></td>
</tr>
<tr class="grey-bg">
<td style="width: 15.5%; text-align: left;">Recommend our<br> company to others</td>
<td><input type="radio" /></td>
<td><input type="radio" /></td>
<td><input type="radio" /></td>
<td><input type="radio" /></td>
<td><input type="radio" /></td>
</tr>
</table>
</div>
<div class="mb-3">
<label><b>Addtional comments or suggestions</b></label>
<textarea rows="6"></textarea>
</div>
</form>
</div>
</body>
</html>