<html>
<head>
<title>My Online Survey</title>
</head>
<body>
<form action="process.php" method="post">
<table border="1">
<tr>
<td>What gender are you?</td>
<td colspan="5"><input type="radio" name="gender" value="Male">Male | <input type="radio" name="gender" value="Female">Female</td>
</tr>
<tr>
<td>What is your age group?</td>
<td colspan="5"><input type="radio" name="age" value="0_8" />0 - 8 | <input type="radio" name="age" value="9_16" />9 - 16 | <input type="radio" name="age" value="17_24" />17 - 24 <br /><input type="radio" name="age" value="25 - 32" />25 - 32 | <input type="radio" name="age" value=" 33 - 40" />33 - 40 | <input type="radio" name="age" value="41_x" />Older than 41</td>
</tr>
<tr>
<td>Was this phone or email support?</td>
<td colspan="5"><input type="radio" name="suptype" value="email" />Email | <input type="radio" name="suptype" value="phone" />Phone</td>
</tr>
<tr>
<td>What is your knowledge with computers?</td>
<td colspan="5"><input type="radio" name="knowledge" value="little" />Little | <input type="radio" name="knowledge" value="some" />Some | <input type="radio" name="knowledge" value="lots" />A Lot | <input type="radio" name="knowledge" value="expert" />Expert</td>
</tr>
<tr>
<td colspan="6" bgcolor="#cccccc"> </td>
</tr>
<tr>
<td></td>
<th>Very Dissatisfied</th>
<th>Dissatisfied</th>
<th>Satisfied</th>
<th>Very Satisfied</th>
<th>Neutral</th>
</tr>
<tr>
<td>Overall how satisfied are you with the support you received?</td>
<td><input type="radio" name="overall" value="0" /></td>
<td><input type="radio" name="overall" value="1" /></td>
<td><input type="radio" name="overall" value="2" /></td>
<td><input type="radio" name="overall" value="3" /></td>
<td><input type="radio" name="overall" value="4" /></td>
</tr>
<tr>
<td>How satisfied are you with the speed of the support?</td>
<td><input type="radio" name="speed" value="0" /></td>
<td><input type="radio" name="speed" value="1" /></td>
<td><input type="radio" name="speed" value="2" /></td>
<td><input type="radio" name="speed" value="3" /></td>
<td><input type="radio" name="speed" value="4" /></td>
</tr>
<tr>
<td>How would you rate the knowledge of the support representative?</td>
<td><input type="radio" name="repknowledge" value="0" /></td>
<td><input type="radio" name="repknowledge" value="1" /></td>
<td><input type="radio" name="repknowledge" value="2" /></td>
<td><input type="radio" name="repknowledge" value="3" /></td>
<td><input type="radio" name="repknowledge" value="4" /></td>
</tr>
<tr>
<td>Would you recommend us to a friend or coworker for support requests in the future?</td>
<td colspan="3"><input type="radio" name="recommend" value="yes" />Yes</td>
<td colspan="2"><input type="radio" name="recommend" value="no" />No</td>
</tr>
<tr>
<td>How satisfied were you with the result of the support?</td>
<td><input type="radio" name="result" value="0" /></td>
<td><input type="radio" name="result" value="1" /></td>
<td><input type="radio" name="result" value="2" /></td>
<td><input type="radio" name="result" value="3" /></td>
<td><input type="radio" name="result" value="4" /></td>
</tr>
<tr>
<td>How would you rate the personability of the support representative?</td>
<td><input type="radio" name="personability" value="0" />0 - Not Very</td>
<td><input type="radio" name="personability" value="1" />1</td>
<td><input type="radio" name="personability" value="2" />2</td>
<td><input type="radio" name="personability" value="3" />3</td>
<td><input type="radio" name="personability" value="4" />4 - Very</td>
</tr>
</table><br />
<input type="submit" value="submit" name="submit" />
</form>
</body>
</html>