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Form analysis
1 forms found in the DOM

POST submit.php

<form action="submit.php" method="post">
  <div class="row">
    <div class="form-group col-lg-4">
      <label for="first_name">First Name</label>
      <input type="text" name="first_name" id="first_name" class="form-control" required="">
    </div>
    <div class="form-group col-lg-4">
      <label for="middle_name">Middle Name</label>
      <input type="text" name="middle_name" id="middle_name" class="form-control" required="">
    </div>
    <div class="form-group col-lg-4">
      <label for="last_name">Last Name</label>
      <input type="text" name="last_name" id="last_name" class="form-control" required="">
    </div>
  </div>
  <div class="row">
    <div class="mt-3 form-group col-lg-4">
      <label for="dob">Date of Birth (Minimum age 18 years)</label>
      <input type="date" name="dob" id="dob" class="form-control" required="">
    </div>
  </div>
  <div class="row">
    <div class="mt-3 form-group col-lg-4">
      <label>Gender</label><br>
      <div class="form-check form-check-inline">
        <input class="form-check-input" type="radio" name="gender" id="male" value="male" required="">
        <label class="form-check-label" for="male">Male</label>
      </div><br>
      <div class="form-check form-check-inline">
        <input class="form-check-input" type="radio" name="gender" id="female" value="female" required="">
        <label class="form-check-label" for="female">Female</label>
      </div>
    </div>
  </div>
  <div class="row">
    <div class="mt-3 form-group col-lg-6">
      <label for="phone">Phone Number</label>
      <input type="tel" name="phone" id="phone" class="form-control" required="">
    </div>
  </div>
  <div class="row">
    <div class="mt-3 form-group col-lg-6">
      <label for="email">Email</label>
      <input type="email" name="email" id="email" class="form-control" required="">
    </div>
  </div>
  <div class="row">
    <div class="mt-3 form-group col-lg-12">
      <label for="address1">Address Line 1</label>
      <input type="text" name="address1" id="address1" class="form-control" required="">
    </div>
  </div>
  <div class="row">
    <div class="form-group col-lg-6">
      <label for="city">City</label>
      <input type="text" name="city" id="city" class="form-control" required="">
    </div>
    <div class="form-group col-lg-6">
      <label for="state">State</label>
      <select name="state" id="state" class="form-control" required="">
        <option value="">Select a State</option>
        <option value="state1">State 1</option>
        <option value="state2">State 2</option>
        <!-- Add more states as needed -->
      </select>
    </div>
  </div>
  <div class="row">
    <div class="form-group col-lg-6">
      <label for="zip">Zip Code</label>
      <input type="text" name="zip" id="zip" class="form-control" required="">
    </div>
  </div>
  <div class="row">
    <div class="mt-3 form-group col-lg-12">
      <p>Question 1:</p>
      <div class="form-check">
        <input class="form-check-input" type="radio" name="question1" id="option1" value="option1" required="">
        <label class="form-check-label" for="option1">Option 1</label>
      </div>
      <div class="form-check">
        <input class="form-check-input" type="radio" name="question1" id="option2" value="option2" required="">
        <label class="form-check-label" for="option2">Option 2</label>
      </div>
      <!-- Add more options as needed -->
    </div>
  </div>
  <!-- Add more questions here -->
  <div class="row">
    <div class="form-group col-lg-12">
      <div class="form-check">
        <input class="form-check-input" type="checkbox" id="confirmation" required="">
        <label class="form-check-label" for="confirmation">I confirm all the information provided is accurate.</label>
      </div>
    </div>
  </div>
  <div class="row">
    <div class="form-group col-lg-12">
      <label for="lab_cost">Lab Cost - $25</label>
    </div>
  </div>
  <div class="row">
    <div class="form-group col-lg-6">
      <label for="donation">Donation Amount</label>
      <input type="number" name="donation" id="donation" class="form-control">
    </div>
  </div>
  <div class="row">
    <div class="form-group col-lg-12">
      <input type="submit" name="submit" id="submit" class="btn btn-primary">
    </div>
  </div>
</form>

Text Content

HEALTH FAIR 2023

First Name
Middle Name
Last Name
Date of Birth (Minimum age 18 years)
Gender

Male

Female
Phone Number
Email
Address Line 1
City
State Select a State State 1 State 2
Zip Code

Question 1:

Option 1
Option 2
I confirm all the information provided is accurate.
Lab Cost - $25
Donation Amount