A Web Page Containing a Form

A useless form with a lot of widgets that does nothing

Last name:

First name:

Check if on medication. (These are checkboxes.)
Check if drowsy.
Check if the level of pain is intolerable.

What is your favorite month? (These are radio buttons.)
January
February
March
April
May
June
July
August
September
October
November
December

What is your favorite borough of New York City? (This is a pop-up menu.)


What is your height in inches (to the nearest hundredth)?


What is your favorite color?


Please adjust the volume.
(Low) (High)

What is the most significant date in human history?


When is zero hour?


Pick a week.


What is his phone number?




Erase all the data you entered into this form.