| {% extends "base.html" %} {% block content %} |
| <link |
| rel="stylesheet" |
| href="{{ url_for('static', filename='css/new_test.css') }}" |
| /> |
|
|
| <div class="new-test-container"> |
| <div |
| class="d-flex justify-content-between align-items-center pt-3 pb-2 mb-4 border-bottom" |
| > |
| <h1 class="h2">New Test - Step 1: Symptoms</h1> |
| <a |
| href="{{ url_for('main.dashboard') }}" |
| class="btn btn-sm btn-outline-secondary" |
| >Cancel</a |
| > |
| </div> |
| {% include '_flash_messages.html' %} |
|
|
| <form |
| action="{{ url_for('main.new_test') }}" |
| method="post" |
| > |
| <div class="card shadow-sm"> |
| <div class="card-body p-0"> |
| <div class="symptom-slider-container"> |
| <div class="symptom-slider-wrapper"> |
| |
| <div class="symptom-slide"> |
| <h3>Do you experience tremors?</h3> |
| <div class="form-check"> |
| <input |
| type="radio" |
| name="tremor" |
| value="at_rest" |
| id="tremor_rest" |
| class="form-check-input" |
| required |
| /> |
| <label |
| for="tremor_rest" |
| class="form-check-label" |
| >Yes, when my hands are resting.</label |
| > |
| </div> |
| <div class="form-check"> |
| <input |
| type="radio" |
| name="tremor" |
| value="action" |
| id="tremor_action" |
| class="form-check-input" |
| /> |
| <label |
| for="tremor_action" |
| class="form-check-label" |
| >Yes, when I am performing an action.</label |
| > |
| </div> |
| <div class="form-check"> |
| <input |
| type="radio" |
| name="tremor" |
| value="no" |
| id="tremor_no" |
| class="form-check-input" |
| /> |
| <label |
| for="tremor_no" |
| class="form-check-label" |
| >No, I do not experience tremors.</label |
| > |
| </div> |
| <button |
| type="button" |
| class="btn btn-primary next-btn" |
| > |
| Next → |
| </button> |
| </div> |
|
|
| |
| <div class="symptom-slide"> |
| <h3>Do you experience stiffness or slowness?</h3> |
| <div class="form-check"> |
| <input |
| type="radio" |
| name="stiffness" |
| value="yes" |
| id="stiffness_yes" |
| class="form-check-input" |
| required |
| /> |
| <label |
| for="stiffness_yes" |
| class="form-check-label" |
| >Yes, my limbs feel rigid or I move slower.</label |
| > |
| </div> |
| <div class="form-check"> |
| <input |
| type="radio" |
| name="stiffness" |
| value="no" |
| id="stiffness_no" |
| class="form-check-input" |
| /> |
| <label |
| for="stiffness_no" |
| class="form-check-label" |
| >No, I have not noticed this.</label |
| > |
| </div> |
| <button |
| type="button" |
| class="btn btn-primary next-btn" |
| > |
| Next → |
| </button> |
| </div> |
|
|
| |
| <div class="symptom-slide"> |
| <h3>Do you have balance or walking issues?</h3> |
| <div class="form-check"> |
| {# The name attribute is now correctly 'walking_issue' #} |
| <input |
| type="radio" |
| name="walking_issue" |
| value="yes" |
| id="balance_yes" |
| class="form-check-input" |
| required |
| /> |
| <label |
| for="balance_yes" |
| class="form-check-label" |
| >Yes, I feel unsteady or have shuffling steps.</label |
| > |
| </div> |
| <div class="form-check"> |
| {# The name attribute is now correctly 'walking_issue' #} |
| <input |
| type="radio" |
| name="walking_issue" |
| value="no" |
| id="balance_no" |
| class="form-check-input" |
| /> |
| <label |
| for="balance_no" |
| class="form-check-label" |
| >No, my balance and walking feel normal.</label |
| > |
| </div> |
| <button |
| type="button" |
| class="btn btn-primary next-btn" |
| > |
| Next → |
| </button> |
| </div> |
|
|
| |
| <div class="symptom-slide"> |
| <h3>Final Details</h3> |
| <div class="mb-3"> |
| <label |
| for="age" |
| class="form-label fw-bold" |
| >Your Age:</label |
| > |
| <input |
| type="number" |
| name="age" |
| id="age" |
| class="form-control" |
| required |
| /> |
| </div> |
| <div class="mb-3"> |
| <label |
| for="gender" |
| class="form-label fw-bold" |
| >Your Gender:</label |
| > |
| <select |
| name="gender" |
| id="gender" |
| class="form-select" |
| required |
| > |
| <option |
| value="" |
| disabled |
| selected |
| > |
| Select... |
| </option> |
| <option value="Male">Male</option> |
| <option value="Female">Female</option> |
| <option value="Other">Other</option> |
| </select> |
| </div> |
| <div class="mb-3"> |
| <label |
| for="other_symptoms" |
| class="form-label fw-bold" |
| >Other symptoms or notes:</label |
| > |
| <textarea |
| name="other_symptoms" |
| id="other_symptoms" |
| rows="2" |
| class="form-control" |
| placeholder="(e.g., changes in handwriting)" |
| ></textarea> |
| </div> |
| <div class="d-grid mt-4"> |
| <button |
| type="submit" |
| class="btn btn-success btn-lg" |
| > |
| Continue to Audio Test → |
| </button> |
| </div> |
| </div> |
| </div> |
| </div> |
| </div> |
| </div> |
| </form> |
| </div> |
| {% endblock %} {% block scripts %} |
| <script |
| src="{{ url_for('static', filename='js/new_test.js') }}" |
| defer |
| ></script> |
| {% endblock %} |
|
|