COVID-19 SELF TEST

by Good Muyis

HTML

<script src="https://code.jquery.com/jquery-3.4.1.slim.js"></script>
<link rel="stylesheet" href="https://stackpath.bootstrapcdn.com/bootstrap/4.4.1/css/bootstrap.css">
<script src="https://cdnjs.cloudflare.com/ajax/libs/popper.js/1.16.0/umd/popper.js"></script>
<script src="https://stackpath.bootstrapcdn.com/bootstrap/4.4.1/js/bootstrap.js"></script>
<link rel="stylesheet" href="https://stackpath.bootstrapcdn.com/font-awesome/4.7.0/css/font-awesome.css">
<form method="post" action="./" id="form1">
  <div class="aspNetHidden">
    <input type="hidden" name="__EVENTTARGET" id="__EVENTTARGET" value="">
    <input type="hidden" name="__EVENTARGUMENT" id="__EVENTARGUMENT" value="">
    <input type="hidden" name="__LASTFOCUS" id="__LASTFOCUS" value="">
    <input type="hidden" name="__VIEWSTATE" id="__VIEWSTATE" value="yVKdJAcBwz4pT4exFq3Ba4Ln9prIzLCX3TmjF5Rknyn/i6BDn/cLJIFnKiqJPDO3KTNYKcjfeEybsKAd6z4+C9euIoaPYtlmFLU4WQJLBgo=">
  </div>

  <script type="text/javascript">
    //<![CDATA[
    var theForm = document.forms['form1'];
    if (!theForm) {
      theForm = document.form1;
    }

    function __doPostBack(eventTarget, eventArgument) {
      if (!theForm.onsubmit || (theForm.onsubmit() != false)) {
        theForm.__EVENTTARGET.value = eventTarget;
        theForm.__EVENTARGUMENT.value = eventArgument;
        theForm.submit();
      }
    }
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  </script>


  <div class="aspNetHidden">

    <input type="hidden" name="__VIEWSTATEGENERATOR" id="__VIEWSTATEGENERATOR" value="90059987">
    <input type="hidden" name="__EVENTVALIDATION" id="__EVENTVALIDATION" value="A6KPt2e3ZPmbqGHR3irV6O/QowBBlPPusdS62ZYPtgLpIL6wITOYqcOY26glql8Rk+GzR6bKBHpCxZmYxe15WQQrdsapG4d+jci4wD8ZUxsKqJkkx2gbYo3vCe8nrPrs+L5jnhGRXcjrWQraU01DwS/BXNTvrK1QG/77/OBA1/XwIBM4mk7MQ3PPPThsD5AzHPrehd02r4Y56x0e4Dhgwg==">
  </div>
  <div class="container-md ">

    <div class="d-flex justify-content-center  mt-2">

      <div class="row">
        <div class="col-md-5 "><img src="img/coro.png"...