Notes
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<head>
<title> kişiler bilgiler </title>
</head>
<body bgcolor="grey" >
<form>
<p> KİŞİSEL BİLGİLER </p> <hr>
Adı : <input type="text" name="text"> Soyadı: <input type="text" name="text">
<br>
<br>
adresi: <input type="text" name="text">
<hr>
<p> TIBBİ GEÇMİŞİ </p>
<input type="checkbox"name="hastalık" id="hastalık"> boğmaca
<input type="checkbox"name="hastalık1" id="hastalık1"> kabakulak
<input type="checkbox"name="hastalık2" id="hastalık2"> kızamık
<input type="checkbox"name="hastalık3" id="hastalık3"> suçiçeği
<hr>
<p> İLAÇ TEDAVİSİ </p>
<br>
<p> HALEN KULLANMAKTA OLDUĞUN BİR İLAÇ VAR MI ? </p>
<input type="radio" name="ilaç" volue="0"> EVET
<input type="radio" name="ilaç" volue="1"> HAYIR
<p> EĞER İLAÇ KULLANIYORSANIZ AŞAĞIYA HANGİ İLAÇLAR OLDUĞUNU YAZIN: </p>
<textarea name="adres" rows="7" cols="100"></textarea>
</body>
</html>
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