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pagetwo.html
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<!DOCTYPE html>
<html lang="en">
<head>
<meta charset="UTF-8" />
<meta http-equiv="X-UA-Compatible" content="IE=edge" />
<meta name="viewport" content="width=device-width, initial-scale=1.0" />
<link rel="preconnect" href="https://fonts.googleapis.com">
<link rel="preconnect" href="https://fonts.gstatic.com" crossorigin>
<link href="https://fonts.googleapis.com/css2?family=Abril+Fatface&family=Poppins:ital,wght@0,300;0,400;0,500;0,600;0,700;0,800;1,300;1,500;1,600;1,800&display=swap" rel="stylesheet">
<link rel="stylesheet" href="page2.css" />
<title>ClarityWise</title>
</head>
<body>
<header>
<div class="logo" id="oval">
<h4>
<img src="brain.png" alt="" height="70px"
style="padding-top: 2rem"/>
<a href="/index.html"> ClarityWise</a>
</h4>
</div>
<nav>
<ul>
<li><a class="active" href="/pagetwo.html">Self-Diagnosis Quiz</a></li>
<li><a href="/page3.html">Resources</a></li>
<li><a href="#">FAQ</a></li>
</ul>
</nav>
</header>
<div class="heading">Self-Assessment Quiz</div>
<div class="container">
<header>
<div class="step-row">
<div id="progress"></div>
<div class="step-col"><small>1</small></div>
<div class="step-col"><small>2</small></div>
<div class="step-col"><small>3</small></div>
</div>
</header>
<form id="form1">
<h1>ClarityWise</h1>
<label for="fullname">Full Name:</label>
<input type="text" class="form-control" id="name" /> <br />
<label for="email">Email:</label>
<input type="email" class="form-control" id="email" />
<label for="phone">Telephone Number:</label>
<input type="tel" class="form-control" id="phone" />
<h2>About You</h2>
<label for="age" class="form-label">Age Range:</label>
<input
class="form-control"
list="datalistOptions"
id="age"
placeholder="Age Range...."
/>
<datalist id="datalistOptions">
<option value="11-17"></option>
<option value="18-24"></option>
<option value="25-34"></option>
<option value="35-44"></option>
<option value="45-54"></option>
<option value="55-64"></option>
<option value="65+"></option>
</datalist>
<label for="pronouns">Pronouns:</label>
<input
type="text"
class="form-control"
id="name"
placeholder="she/her/he/him/they/them/ze/zirs...."
/>
<h2>About Your Mental Health</h2>
<label for="diagnosed"
>Have you ever been diagnosed with a mental health condition by a
professional (doctor, therapist, etc.)?</label
>
<input type="text" class="form-control" id="treatment" />
<label for="treatment"
>Have you ever received treatment/support for a mental health
problem?</label
>
<div class="btn-box">
<button type="button" id="next1">Next</button>
</div>
</form>
<form id="form2">
<h3>
Over the last month, how often have you been bothered by the following
problems?
</h3>
<label for="nervous">Feeling nervous, anxious, or on edge</label>
<input
list="surveyselection"
id="nervous"
name="choices"
placeholder="Choose From Below"
/>
<datalist id="surveyselection">
<option value="Not At All"></option>
<option value="Several Days"></option>
<option value="More Than Half The Days"></option>
<option value="Nearly Every Day"></option>
</datalist>
<label for="worry" class="form-label"
>Worrying too much about different things</label
>
<input
list="surveyselection"
id="worry"
placeholder="Choose From Below"
/>
<datalist id="surveyselection">
<option value="Not At All"></option>
<option value="Several Days"></option>
<option value="More Than Half The Days"></option>
<option value="Nearly Every Day"></option>
</datalist>
<label for="restless" class="form-label"
>Being so restless that it is hard to sit still</label
>
<input
class="form-control"
list="surveyselection"
id="restless"
placeholder="Choose From Below"
/>
<datalist id="surveyselection">
<option value="Not At All"></option>
<option value="Several Days"></option>
<option value="More Than Half The Days"></option>
<option value="Nearly Every Day"></option>
</datalist>
<label for="nervous">Feeling nervous, anxious, or on edge</label>
<input
list="surveyselection"
id="nervous"
name="choices"
placeholder="Choose From Below"
/>
<datalist id="surveyselection">
<option value="Not At All"></option>
<option value="Several Days"></option>
<option value="More Than Half The Days"></option>
<option value="Nearly Every Day"></option>
</datalist>
<label for="nervous"> Becoming easily annoyed or irritable</label>
<input
list="surveyselection"
id="nervous"
name="choices"
placeholder="Choose From Below"
/>
<datalist id="surveyselection">
<option value="Not At All"></option>
<option value="Several Days"></option>
<option value="More Than Half The Days"></option>
<option value="Nearly Every Day"></option>
</datalist>
<label for="nervous"
>Do you tend to avoid or delay getting started on a new important
task?</label
>
<input
list="surveyselection"
id="nervous"
name="choices"
placeholder="Choose From Below"
/>
<datalist id="surveyselection">
<option value="Not At All"></option>
<option value="Several Days"></option>
<option value="More Than Half The Days"></option>
<option value="Nearly Every Day"></option>
</datalist>
<label for="nervous"
>Do you regularly fail to remember important appointments or
obligations?</label
>
<input
list="surveyselection"
id="nervous"
name="choices"
placeholder="Choose From Below"
/>
<datalist id="surveyselection">
<option value="Not At All"></option>
<option value="Several Days"></option>
<option value="More Than Half The Days"></option>
<option value="Nearly Every Day"></option>
</datalist>
<label for="nervous"
>Do you have difficulty unwinding or feel often on the go?</label
>
<input
list="surveyselection"
id="nervous"
name="choices"
placeholder="Choose From Below"
/>
<datalist id="surveyselection">
<option value="Not At All"></option>
<option value="Several Days"></option>
<option value="More Than Half The Days"></option>
<option value="Nearly Every Day"></option>
</datalist>
<div class="btn-box">
<button type="button" id="next2">Next</button>
</div>
</form>
<form id="form3" >
<label for="nervous"
>Do you have difficulty concentrating on people when they are speaking
to you?</label
>
<input
list="surveyselection"
id="nervous"
name="choices"
placeholder="Choose From Below"
/>
<datalist id="surveyselection">
<option value="Not At All"></option>
<option value="Several Days"></option>
<option value="More Than Half The Days"></option>
<option value="Nearly Every Day"></option>
</datalist>
<label for="nervous"
>Do you frequently misplace things (or have difficulty finding
them)?</label
>
<input
list="surveyselection"
id="nervous"
name="choices"
placeholder="Choose From Below"
/>
<datalist id="surveyselection">
<option value="Not At All"></option>
<option value="Several Days"></option>
<option value="More Than Half The Days"></option>
<option value="Nearly Every Day"></option>
</datalist>
<label for="nervous"
>Are you typically distracted (or find it hard to focus) when there is
activity or noise around you?</label
>
<input
list="surveyselection"
id="nervous"
name="choices"
placeholder="Choose From Below"
/>
<datalist id="surveyselection">
<option value="Not At All"></option>
<option value="Several Days"></option>
<option value="More Than Half The Days"></option>
<option value="Nearly Every Day"></option>
</datalist>
<label for="nervous">Little interest or pleasure in doing things</label>
<input
list="surveyselection"
id="nervous"
name="choices"
placeholder="Choose From Below"
/>
<datalist id="surveyselection">
<option value="Not At All"></option>
<option value="Several Days"></option>
<option value="More Than Half The Days"></option>
<option value="Nearly Every Day"></option>
</datalist>
<label for="nervous">Feeling down, depressed, or hopeless</label>
<input
list="surveyselection"
id="nervous"
name="choices"
placeholder="Choose From Below"
/>
<datalist id="surveyselection">
<option value="Not At All"></option>
<option value="Several Days"></option>
<option value="More Than Half The Days"></option>
<option value="Nearly Every Day"></option>
</datalist>
<label for="nervous">Poor appetite or overeating</label>
<input
list="surveyselection"
id="nervous"
name="choices"
placeholder="Choose From Below"
/>
<datalist id="surveyselection">
<option value="Not At All"></option>
<option value="Several Days"></option>
<option value="More Than Half The Days"></option>
<option value="Nearly Every Day"></option>
</datalist>
<label for="nervous"
>Feeling bad about yourself - or that you are a failure or have let
yourself or your family down</label
>
<input
list="surveyselection"
id="nervous"
name="choices"
placeholder="Choose From Below"
/>
<!-- <datalist id="surveyselection">
<option value="Not At All"></option>
<option value="Several Days"></option>
<option value="More Than Half The Days"></option>
<option value="Nearly Every Day"></option>
</datalist>
<label for="nervous"
>Trouble falling or staying asleep, or sleeping too much</label
>
<input
list="surveyselection"
id="nervous"
name="choices"
placeholder="Choose From Below"
/>
<datalist id="surveyselection">
<option value="Not At All"></option>
<option value="Several Days"></option>
<option value="More Than Half The Days"></option>
<option value="Nearly Every Day"></option>
</datalist> -->
<label for="moreinfo">Anything you would like to add:</label>
<input type="text" class="form-control" id="name" />
<div class="btn-box">
<button type="submit" id="submit">Submit</button>
</div>
</form>
<section id="toggle">
<form id="form4">
<span id="displaymessage"></span>
</form>
</div>
</section>
<script src="script.js"></script>
</body>
</html>