<html>
<head>
    <title>Health Assessment Form</title>
    <style>
        body {
            font-family: Arial, sans-serif;
            margin: 0;
            padding: 0;
            background: white;
            color: #333;
        }
        header {
            background: #4caf50;
            color: white;
            text-align: center;
            padding: 15px;
        }
        .content {
            max-width: 600px;
            margin: 20px auto;
            background: white;
            padding: 20px;
            border-radius: 8px;
            box-shadow: 0 2px 5px rgba(0, 0, 0, 0.1);
        }
        h1, h2 {
            color: #4caf50;
        }
        form {
            display: grid;
            gap: 15px;
        }
        label {
            font-weight: bold;
        }
        input[type="text"], 
        input[type="number"] {
            width: 100%;
            padding: 10px;
            border: 1px solid white;
            border-radius: 5px;
        }
        .options label {
            display: inline-block;
            margin-right: 10px;
        }
        button {
            background: #4caf50;
            color: #fff;
            border: none;
            padding: 10px;
            border-radius: 5px;
            cursor: pointer;
        }
        footer {
            text-align: center;
            margin-top: 20px;
            font-size: 14px;
            color: #777;
        }
    </style>
</head>
<body>
    <header>
        <h1>Health Assessment Form</h1>
    </header>
    <div class="content">
        <h2>Assess Your Health</h2>
        <p>Fill out this form to assess your health and lifestyle practices.</p>
        <form>
            <label for="username">Name:</label>
            <input type="text" id="username" name="username" placeholder="Enter your name" required>
            
            <label for="age">Age:</label>
            <input type="number" id="age" name="age" placeholder="Enter your age" required>
            
            <label>Gender:</label>
            <div class="options">
                <label><input type="radio" name="gender" value="male"> Male</label>
                <label><input type="radio" name="gender" value="female"> Female</label>
            </div>
            
            <label>Healthy Lifestyle Choices:</label>
            <div class="options">
                <label><input type="checkbox" name="lifestyle" value="exercise"> Exercise regularly</label>
                <label><input type="checkbox" name="lifestyle" value="fruits"> Eat fruits and vegetables</label>
                <label><input type="checkbox" name="lifestyle" value="water"> Drink plenty of water</label>
                <label><input type="checkbox" name="lifestyle" value="avoid-junk"> Avoid junk food</label>
            </div>
            
            <button type="submit">Submit</button>
        </form>
    </div>
    <footer>&copy; 2024 Health Assessment.  Made by Abdallah Masood All rights reserved.</footer>
</body>
</html>