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askExpert.html
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<!DOCTYPE html>
<html lang="en">
<head>
<title>NU Insurance</title>
<meta charset="utf-8">
<meta name="viewport" content="width=device-width, initial-scale=1">
<link rel="stylesheet" href="http://maxcdn.bootstrapcdn.com/bootstrap/3.3.6/css/bootstrap.min.css">
<link rel="stylesheet" href="index.css">
<script src="https://ajax.googleapis.com/ajax/libs/jquery/1.12.0/jquery.min.js"></script>
<script src="http://maxcdn.bootstrapcdn.com/bootstrap/3.3.6/js/bootstrap.min.js"></script>
<script src="askExpert.js"></script>
</head>
<body>
<nav class="navbar navbar-default">
<div class="container-fluid">
<div class="navbar-header">
<a class="navbar-brand" href="index.html">NU Insurance</a>
</div>
<ul class="nav navbar-nav navbar-right">
<li><a href="#"><span class="glyphicon glyphicon-user"></span> Sign Up</a></li>
<li><a href="#"><span class="glyphicon glyphicon-log-in"></span> Login</a></li>
</ul>
<ul class="nav navbar-nav">
<li class="dropdown"><a class="dropdown-toggle" data-toggle="dropdown" href="#">Ask a Healthcare Question <span class="caret"></span></a>
<ul class="dropdown-menu ask">
<li>
<a href="askExpert.html"><img src = expert.png width="200";><br>Ask an Expert</a>
</li>
<li><a href="askCommunity.html"><img src = community.png width="200";><br>Ask the Community</a></li>
<li><a href="search.html"><img src = search.png width="200";><br>Search for an Answer</a></li>
</ul>
</li>
<li class="dropdown"><a class="dropdown-toggle" data-toggle="dropdown" href="#">Find a Plan <span class="caret"></span></a>
<ul class="dropdown-menu find">
<li><a href="searchPlan.html"><img src = search.png width="200";><br>Search for a Plan</a></li>
<li><a href="persPan.html"><img src = personal.png width="200";><br>Choose a Personalized Plan</a></li>
</ul>
</li>
<li class = "dropdown"><a href="dashboard.html">Your Portal</a></li>
<li class="dropdown"><a class="dropdown-toggle" data-toggle="dropdown" href="#">Help <span class="caret"></span></a>
<ul class="dropdown-menu help">
<li><a href="term.html">Common Terminology</a></li>
<li><a href="faq.html">FAQ</a></li>
<li><a href="contact.html">Contact Us</a></li>
</ul>
</li>
</ul>
</div>
</nav>
<div class="container" id="QuestionForm">
<!-- <img src = expert.png width="200" align="right";> -->
<div class = "pageTitle">
<h1>Ask An Expert</h1>
<p>Enter your question below along with some key relevant information.</p>
</div>
<form id="submitForm">
<div class="form-group">
<label for="age">Age</label>
<input type="number" class="form-control" id="age" min="0" max="150" placeholder="Eg: 25" required>
</div>
<div class="checkbox">
<label>
<input type="checkbox" onclick="document.getElementById('age').disabled=this.checked;"> Don't include my age.
</label>
</div>
<div class="form-group">
<label for="income">Annual Income ($)</label>
<input type="number" class="form-control" id="income" placeholder="Eg: 40,000" required>
</div>
<div class="checkbox">
<label>
<input type="checkbox" onclick="document.getElementById('income').disabled=this.checked;"> Don't include my income.
</label>
</div>
<div class="form-group">
<label for="zip">Zip Code</label>
<input type="number" class="form-control" id="zip" placeholder="Eg: 60201" min="10000" max = "99999" required>
</div>
<div class="form-group">
<label for="currentPlan">Do you have a current plan?</label>
<div class="radio">
<label>
<input type="radio" name="optionsRadio" id="optionsRadios1" value="option1" onclick="document.getElementById('currentPlan').disabled=!this.checked;" checked>
Yes, I would like to share it.
</label>
</div>
<div class="radio">
<label>
<input type="radio" name="optionsRadio" id="optionsRadios2" value="option2" onclick="document.getElementById('currentPlan').disabled=this.checked;">
Yes, but I prefer not to share it.
</label>
</div>
<div class="radio">
<label>
<input type="radio" name="optionsRadio" id="optionsRadios3" value="option3" onclick="document.getElementById('currentPlan').disabled=this.checked;">
No, I don't.
</label>
</div>
<div>
<input type="text" class="form-control" id="currentPlan" placeholder="Provider and Name Your Current Plan (Eg: Aetna Silver Coverage)">
</div>
</div>
<div class="form-group">
<label for="Question">Please enter your question below.</label>
<textarea class="form-control" id="exampleTextarea" rows="3" required></textarea>
</div>
<div class="form-group">
<label for="questionType">Please select the type of your question.</label>
<select class="form-control" id="typeSelect" required>
<option disabled selected> -- select an option -- </option>
<option>Specific Plan Question</option>
<option>Special Situation Question</option>
<option>Plan Selection Question</option>
<option>Healthcare Question</option>
<option>Others</option>
</select>
</div>
<button type="submit" class="btn btn-primary" id="submit">Submit Your Question</button>
</form>
</div>
<div class="container" id="ThankYouNote">
<h2>Thank you for submitting your question!</h2>
<h2>An expert will reach out to you shortly.</h2>
</div>
</body>
</html>