<!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>