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<!DOCTYPE html> <html> <head> <title>Website raiting form</title> <link href="https://fonts.googleapis.com/css?family=Roboto: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 { padding: 0; margin: 0; outline: none; font-family: Roboto, Arial, sans-serif; font-size: 16px; color: #666; } h1, h3 { padding: 12px 0; font-weight: 400; } h1 { font-size: 28px; } .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; } input[type=radio] { display: none; } label.radio { position: relative; display: inline-block; text-indent: 32px; cursor: pointer; } label.radio:before { content: ""; position: absolute; left: 0; width: 18px; height: 18px; border-radius: 50%; border: 0.5px solid #8ebf42; background: #fff; } 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; } 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>Website Raiting Form</h1> <form action="/"> <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="Name" 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>Rate Our Website</h3> <div> <input type="radio" value="none" id="radioOne" name="grade" checked/> <label for="radioOne" class="radio">Excellent</label> </div> <div> <input type="radio" value="none" id="radioTwo" name="grade" /> <label for="radioTwo" class="radio">Very Good</label> </div> <div> <input type="radio" value="none" id="radioThree" name="grade" /> <label for="radioThree" class="radio">Good</label> </div> <div> <input type="radio" value="none" id="radioFour" name="grade" /> <label for="radioFour" class="radio">Bad</label> </div> <div> <input type="radio" value="none" id="radioFive" name="grade" /> <label for="radioFive" class="radio">Very Bad</label> </div> </div> <h3>Please Comment on Your Rating</h3> <textarea rows="4"></textarea> <button type="submit" href="/">Submit</button> </form> </div> </body> </html>