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<input> : The Input Field Element

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Summary

The <input> element creates form input fields in PDF documents. Since PDFs are static documents, inputs render as visual representations of form fields with their current values displayed. They can be styled, data-bound, and used to create form-like layouts for invoices, applications, surveys, and other documents that require formatted data display.

Usage

The <input> element creates form fields that:

  • Render as styled boxes displaying static values (not interactive in PDF)
  • Support multiple input types: text, checkbox, radio, button, password, file
  • Display current values from data binding or static content
  • Can be styled with borders, padding, colors, and fonts
  • Support form layouts with labels and fieldsets
  • Show checkboxes and radio buttons as visual indicators (checked/unchecked)
  • Enable creation of professional form templates
  • Support multi-line text areas with appropriate options
<!-- Basic text input with value -->
<input type="text" value="John Doe" />

<!-- Data-bound input field -->
<input type="text" value="" />

<!-- Checkbox (checked state shown visually) -->
<input type="checkbox" value="checked" />

Supported Attributes

Standard HTML Attributes

Attribute Type Description
id string Unique identifier for the element. Used for styling and references.
name string Field name used for form identification and data binding. Auto-generated if not provided.
class string CSS class name(s) for styling. Multiple classes separated by spaces.
style string Inline CSS styles applied directly to the element.
title string Sets the outline/bookmark title for the input.
hidden string Controls visibility. Set to “hidden” to hide the element, or omit/empty to show.

Input-Specific Attributes

Attribute Type Description
type string Input type: text (default), checkbox, radio, button, password, file.
value string The current/default value displayed in the field. Supports data binding.
default-value string Fallback value if no value is specified.
options FormFieldOptions Field options: None, ReadOnly, Required, NoExport, MultiLine, Password, File.

Type Attribute Values

Type Description Visual Representation
text Single-line text input (default) Text displayed in bordered box
checkbox Checkbox input Checked: shows checkmark symbol (✓ or ☑), Unchecked: empty box
radio Radio button input Selected: filled circle (⦿), Unselected: empty circle (○)
button Button field Text displayed as button
password Password field Text displayed (non-masked in PDF)
file File upload field File path or filename displayed

CSS Style Support

The <input> element supports extensive CSS styling:

Sizing:

  • width, height, min-width, max-width, min-height, max-height
  • Default: width: 100% (full width)

Positioning:

  • display: inline-block (default), block, inline, none
  • position: static (default), relative, absolute
  • float: left, right, none
  • vertical-align: top, middle, bottom, baseline

Spacing:

  • margin, margin-top, margin-right, margin-bottom, margin-left
  • padding (all variants) - default: 5pt

Visual Styling:

  • border, border-width, border-color, border-style - default: 1pt solid black
  • border-radius - rounded corners
  • background-color, background-image
  • color - text color
  • font-family, font-size, font-weight, font-style

Text Control:

  • text-align: left, center, right
  • line-height, letter-spacing
  • For single-line inputs: word-wrap: nowrap (default)
  • For multi-line inputs: text wrapping enabled

Notes

Static Form Fields in PDF

Input fields in Scryber PDFs are static visual representations, not interactive form fields:

  • Values are rendered as text content in styled boxes
  • Users cannot edit the fields in the PDF viewer
  • Perfect for completed forms, invoices, applications, and reports
  • The visual appearance mimics HTML form fields

Input Types and Rendering

Text Input (type=”text”):

<input type="text" value="John Doe" style="width: 200pt;" />

Renders as: [John Doe____________________] (text in bordered box)

Checkbox (type=”checkbox”):

<!-- Checked checkbox -->
<input type="checkbox" value="checked" />
<!-- Unchecked checkbox -->
<input type="checkbox" value="" />

Renders as: ☑ (checked) or ☐ (unchecked)

Radio Button (type=”radio”):

<!-- Selected radio -->
<input type="radio" value="selected" />
<!-- Unselected radio -->
<input type="radio" value="" />

Renders as: ⦿ (selected) or ○ (unselected)

Multi-line Text (options=”MultiLine”):

<input type="text" value="Line 1&#10;Line 2" options="MultiLine"
       style="height: 100pt;" />

Renders as multi-line text area with text wrapping enabled.

Data Binding

Inputs support dynamic value binding:

<!-- Model: { name: "John Doe", email: "john@example.com" } -->
<input type="text" value="" />
<input type="text" value="" />

<!-- Conditional checkbox -->
<input type="checkbox" value="" />

Value Handling

The value attribute controls what is displayed:

  • Text inputs: Display the value as text
  • Checkbox: Non-empty value = checked (shows ✓), empty/null = unchecked
  • Radio: Non-empty value = selected (shows ⦿), empty/null = unselected
  • Empty value: Shows placeholder or empty field

Field Options

The options attribute accepts these values (can be combined with bitwise OR):

Option Description
None Default behavior, no special options
ReadOnly Indicates read-only field (visual only in PDF)
Required Indicates required field (visual only in PDF)
NoExport Field should not be exported (metadata only)
MultiLine Enables text wrapping for multi-line input (4096)
Password Marks field as password type (8192)
File Marks field as file upload type (1048576)

Example:

<!-- Multi-line text input -->
<input type="text" value="Long text..." options="MultiLine"
       style="height: 80pt;" />

Default Styling

Inputs have these default styles:

  • Border: 1pt solid black
  • Padding: 5pt
  • Width: 100% (full width of container)
  • Display: inline-block
  • Position: static
  • Text wrapping: Disabled (unless MultiLine option set)
  • Overflow: clip

Class Hierarchy

In the Scryber codebase:

  • HTMLInput extends FormInputField extends Panel
  • Uses LayoutEngineInput for custom rendering
  • Supports form field metadata and appearance states

Examples

Basic Text Inputs 

<!-- Simple text input -->
<input type="text" value="John Doe" />

<!-- Text input with specific width -->
<input type="text" value="jane@example.com" style="width: 250pt;" />

<!-- Text input with custom styling -->
<input type="text" value="(555) 123-4567"
       style="width: 150pt; padding: 8pt; border: 2pt solid #336699;
              border-radius: 4pt; font-size: 12pt;" />

Text Inputs with Labels 

<div style="margin-bottom: 10pt;">
    <label style="display: inline-block; width: 100pt; font-weight: bold;">
        Name:
    </label>
    <input type="text" value="John Doe" style="width: 300pt;" />
</div>

<div style="margin-bottom: 10pt;">
    <label style="display: inline-block; width: 100pt; font-weight: bold;">
        Email:
    </label>
    <input type="text" value="john@example.com" style="width: 300pt;" />
</div>

<div style="margin-bottom: 10pt;">
    <label style="display: inline-block; width: 100pt; font-weight: bold;">
        Phone:
    </label>
    <input type="text" value="(555) 123-4567" style="width: 300pt;" />
</div>

Styled Form Inputs 

<style>
    .form-input {
        width: 100%;
        padding: 8pt;
        border: 1pt solid #cccccc;
        border-radius: 3pt;
        font-size: 11pt;
        background-color: #ffffff;
    }
    .form-input:focus {
        border-color: #336699;
    }
</style>

<input type="text" value="Styled Input" class="form-input" />
<input type="text" value="Another Field" class="form-input"
       style="margin-top: 5pt;" />

Checkboxes 

<!-- Checked checkbox -->
<input type="checkbox" value="checked" />
<label style="margin-left: 5pt;">I agree to the terms</label>

<!-- Unchecked checkbox -->
<input type="checkbox" value="" />
<label style="margin-left: 5pt;">Subscribe to newsletter</label>

<!-- Styled checkbox with label -->
<div style="margin: 10pt 0;">
    <input type="checkbox" value="checked"
           style="width: 15pt; height: 15pt; margin-right: 5pt;" />
    <label style="vertical-align: middle;">
        I have read and accept the privacy policy
    </label>
</div>

Radio Buttons 

<!-- Radio button group -->
<div style="margin-bottom: 5pt;">
    <input type="radio" value="selected" name="gender"
           style="width: 15pt; height: 15pt;" />
    <label style="margin-left: 5pt; margin-right: 15pt;">Male</label>

    <input type="radio" value="" name="gender"
           style="width: 15pt; height: 15pt;" />
    <label style="margin-left: 5pt; margin-right: 15pt;">Female</label>

    <input type="radio" value="" name="gender"
           style="width: 15pt; height: 15pt;" />
    <label style="margin-left: 5pt;">Other</label>
</div>

Multi-line Text Input (Text Area) 

<!-- Multi-line input -->
<input type="text" value="This is a longer text&#10;that spans multiple lines&#10;in the input field."
       options="MultiLine"
       style="width: 100%; height: 100pt; padding: 8pt;
              border: 1pt solid #cccccc;" />

<!-- Text area for comments -->
<label style="font-weight: bold; display: block; margin-bottom: 5pt;">
    Comments:
</label>
<input type="text"
       value="Please provide any additional information here..."
       options="MultiLine"
       style="width: 100%; height: 80pt; padding: 10pt;
              border: 1pt solid #999999; font-size: 10pt;" />

Data-Bound Inputs 

<!-- Model: {
    firstName: "John",
    lastName: "Doe",
    email: "john.doe@example.com",
    phone: "(555) 123-4567",
    agreeTerms: true
} -->

<div style="margin-bottom: 10pt;">
    <label style="display: inline-block; width: 120pt;">First Name:</label>
    <input type="text" value="" style="width: 200pt;" />
</div>

<div style="margin-bottom: 10pt;">
    <label style="display: inline-block; width: 120pt;">Last Name:</label>
    <input type="text" value="" style="width: 200pt;" />
</div>

<div style="margin-bottom: 10pt;">
    <label style="display: inline-block; width: 120pt;">Email:</label>
    <input type="text" value="" style="width: 300pt;" />
</div>

<div style="margin-bottom: 10pt;">
    <label style="display: inline-block; width: 120pt;">Phone:</label>
    <input type="text" value="" style="width: 200pt;" />
</div>

<div style="margin-top: 15pt;">
    <input type="checkbox" value="" />
    <label style="margin-left: 5pt;">I agree to the terms and conditions</label>
</div>

Complete Registration Form 

<style>
    .form-section {
        margin-bottom: 20pt;
        padding: 15pt;
        border: 1pt solid #e0e0e0;
        border-radius: 5pt;
    }
    .form-row {
        margin-bottom: 12pt;
    }
    .form-label {
        display: inline-block;
        width: 150pt;
        font-weight: bold;
        color: #333333;
    }
    .form-input {
        width: 300pt;
        padding: 8pt;
        border: 1pt solid #cccccc;
        border-radius: 3pt;
        font-size: 11pt;
    }
</style>

<div class="form-section">
    <h2 style="margin-top: 0; color: #336699;">Personal Information</h2>

    <div class="form-row">
        <label class="form-label">Full Name:</label>
        <input type="text" value="John Doe" class="form-input" />
    </div>

    <div class="form-row">
        <label class="form-label">Date of Birth:</label>
        <input type="text" value="01/15/1985" class="form-input" style="width: 150pt;" />
    </div>

    <div class="form-row">
        <label class="form-label">Email Address:</label>
        <input type="text" value="john.doe@example.com" class="form-input" />
    </div>

    <div class="form-row">
        <label class="form-label">Phone Number:</label>
        <input type="text" value="(555) 123-4567" class="form-input" style="width: 200pt;" />
    </div>
</div>

<div class="form-section">
    <h2 style="margin-top: 0; color: #336699;">Address</h2>

    <div class="form-row">
        <label class="form-label">Street Address:</label>
        <input type="text" value="123 Main Street" class="form-input" />
    </div>

    <div class="form-row">
        <label class="form-label">City:</label>
        <input type="text" value="Springfield" class="form-input" style="width: 200pt;" />
    </div>

    <div class="form-row">
        <label class="form-label">State:</label>
        <input type="text" value="IL" class="form-input" style="width: 80pt;" />
        <label style="margin-left: 20pt; margin-right: 10pt; font-weight: bold;">ZIP:</label>
        <input type="text" value="62701" class="form-input" style="width: 100pt;" />
    </div>
</div>

Survey Form with Checkboxes 

<h2 style="color: #336699;">Customer Satisfaction Survey</h2>

<div style="margin-bottom: 15pt;">
    <label style="font-weight: bold; display: block; margin-bottom: 8pt;">
        Which products have you purchased? (Select all that apply)
    </label>

    <div style="margin-left: 10pt;">
        <div style="margin-bottom: 8pt;">
            <input type="checkbox" value="checked" style="width: 15pt; height: 15pt;" />
            <label style="margin-left: 8pt;">Product A - Widget</label>
        </div>

        <div style="margin-bottom: 8pt;">
            <input type="checkbox" value="checked" style="width: 15pt; height: 15pt;" />
            <label style="margin-left: 8pt;">Product B - Gadget</label>
        </div>

        <div style="margin-bottom: 8pt;">
            <input type="checkbox" value="" style="width: 15pt; height: 15pt;" />
            <label style="margin-left: 8pt;">Product C - Tool</label>
        </div>

        <div style="margin-bottom: 8pt;">
            <input type="checkbox" value="checked" style="width: 15pt; height: 15pt;" />
            <label style="margin-left: 8pt;">Product D - Device</label>
        </div>
    </div>
</div>

<div style="margin-bottom: 15pt;">
    <label style="font-weight: bold; display: block; margin-bottom: 8pt;">
        How satisfied are you with our service?
    </label>

    <div style="margin-left: 10pt;">
        <div style="margin-bottom: 8pt;">
            <input type="radio" value="" style="width: 15pt; height: 15pt;" />
            <label style="margin-left: 8pt;">Very Satisfied</label>
        </div>

        <div style="margin-bottom: 8pt;">
            <input type="radio" value="selected" style="width: 15pt; height: 15pt;" />
            <label style="margin-left: 8pt;">Satisfied</label>
        </div>

        <div style="margin-bottom: 8pt;">
            <input type="radio" value="" style="width: 15pt; height: 15pt;" />
            <label style="margin-left: 8pt;">Neutral</label>
        </div>

        <div style="margin-bottom: 8pt;">
            <input type="radio" value="" style="width: 15pt; height: 15pt;" />
            <label style="margin-left: 8pt;">Dissatisfied</label>
        </div>

        <div style="margin-bottom: 8pt;">
            <input type="radio" value="" style="width: 15pt; height: 15pt;" />
            <label style="margin-left: 8pt;">Very Dissatisfied</label>
        </div>
    </div>
</div>

<div style="margin-bottom: 15pt;">
    <label style="font-weight: bold; display: block; margin-bottom: 8pt;">
        Additional Comments:
    </label>
    <input type="text"
           value="The service was excellent and the staff was very helpful. I would definitely recommend this company to others."
           options="MultiLine"
           style="width: 100%; height: 80pt; padding: 10pt;
                  border: 1pt solid #cccccc; font-size: 10pt;" />
</div>

Invoice Form with Styled Inputs 

<style>
    .invoice-header {
        background-color: #336699;
        color: white;
        padding: 15pt;
        margin-bottom: 20pt;
    }
    .invoice-row {
        margin-bottom: 10pt;
    }
    .invoice-label {
        display: inline-block;
        width: 120pt;
        font-weight: bold;
        color: #555555;
    }
    .invoice-input {
        width: 250pt;
        padding: 6pt;
        border: 1pt solid #cccccc;
        background-color: #f9f9f9;
        font-size: 11pt;
    }
</style>

<div class="invoice-header">
    <h1 style="margin: 0; font-size: 20pt;">INVOICE</h1>
</div>

<div style="margin-bottom: 25pt;">
    <h3 style="color: #336699; border-bottom: 2pt solid #336699; padding-bottom: 5pt;">
        Bill To
    </h3>

    <div class="invoice-row">
        <label class="invoice-label">Customer Name:</label>
        <input type="text" value="Acme Corporation" class="invoice-input" />
    </div>

    <div class="invoice-row">
        <label class="invoice-label">Address:</label>
        <input type="text" value="456 Business Ave" class="invoice-input" />
    </div>

    <div class="invoice-row">
        <label class="invoice-label">City, State ZIP:</label>
        <input type="text" value="Chicago, IL 60601" class="invoice-input" />
    </div>

    <div class="invoice-row">
        <label class="invoice-label">Email:</label>
        <input type="text" value="billing@acme.com" class="invoice-input" />
    </div>
</div>

<div style="margin-bottom: 25pt;">
    <h3 style="color: #336699; border-bottom: 2pt solid #336699; padding-bottom: 5pt;">
        Invoice Details
    </h3>

    <div class="invoice-row">
        <label class="invoice-label">Invoice Number:</label>
        <input type="text" value="INV-2024-001" class="invoice-input" style="width: 150pt;" />
    </div>

    <div class="invoice-row">
        <label class="invoice-label">Invoice Date:</label>
        <input type="text" value="January 15, 2024" class="invoice-input" style="width: 150pt;" />
    </div>

    <div class="invoice-row">
        <label class="invoice-label">Due Date:</label>
        <input type="text" value="February 15, 2024" class="invoice-input" style="width: 150pt;" />
    </div>

    <div class="invoice-row">
        <label class="invoice-label">Payment Terms:</label>
        <input type="text" value="Net 30" class="invoice-input" style="width: 150pt;" />
    </div>
</div>

Application Form with Radio Buttons 

<h2 style="color: #336699; border-bottom: 2pt solid #336699; padding-bottom: 10pt;">
    Job Application Form
</h2>

<div style="margin-bottom: 15pt;">
    <label style="font-weight: bold;">Full Name:</label>
    <input type="text" value="Jane Smith" style="width: 100%; padding: 8pt;
           border: 1pt solid #cccccc; margin-top: 5pt;" />
</div>

<div style="margin-bottom: 15pt;">
    <label style="font-weight: bold;">Email Address:</label>
    <input type="text" value="jane.smith@email.com" style="width: 100%; padding: 8pt;
           border: 1pt solid #cccccc; margin-top: 5pt;" />
</div>

<div style="margin-bottom: 15pt;">
    <label style="font-weight: bold; display: block; margin-bottom: 8pt;">
        Position Applied For:
    </label>

    <div style="margin-left: 10pt;">
        <div style="margin-bottom: 6pt;">
            <input type="radio" value="" style="width: 15pt; height: 15pt;" />
            <label style="margin-left: 8pt;">Software Engineer</label>
        </div>

        <div style="margin-bottom: 6pt;">
            <input type="radio" value="selected" style="width: 15pt; height: 15pt;" />
            <label style="margin-left: 8pt;">Senior Developer</label>
        </div>

        <div style="margin-bottom: 6pt;">
            <input type="radio" value="" style="width: 15pt; height: 15pt;" />
            <label style="margin-left: 8pt;">Team Lead</label>
        </div>

        <div style="margin-bottom: 6pt;">
            <input type="radio" value="" style="width: 15pt; height: 15pt;" />
            <label style="margin-left: 8pt;">Project Manager</label>
        </div>
    </div>
</div>

<div style="margin-bottom: 15pt;">
    <label style="font-weight: bold; display: block; margin-bottom: 8pt;">
        Years of Experience:
    </label>

    <div style="margin-left: 10pt;">
        <div style="margin-bottom: 6pt;">
            <input type="radio" value="" style="width: 15pt; height: 15pt;" />
            <label style="margin-left: 8pt;">0-2 years</label>
        </div>

        <div style="margin-bottom: 6pt;">
            <input type="radio" value="" style="width: 15pt; height: 15pt;" />
            <label style="margin-left: 8pt;">3-5 years</label>
        </div>

        <div style="margin-bottom: 6pt;">
            <input type="radio" value="selected" style="width: 15pt; height: 15pt;" />
            <label style="margin-left: 8pt;">6-10 years</label>
        </div>

        <div style="margin-bottom: 6pt;">
            <input type="radio" value="" style="width: 15pt; height: 15pt;" />
            <label style="margin-left: 8pt;">10+ years</label>
        </div>
    </div>
</div>

<div style="margin-bottom: 15pt;">
    <label style="font-weight: bold; display: block; margin-bottom: 8pt;">
        Cover Letter:
    </label>
    <input type="text"
           value="I am excited to apply for this position. With over 8 years of experience in software development, I have developed strong skills in multiple programming languages and frameworks. I am passionate about creating efficient, scalable solutions and would love the opportunity to contribute to your team."
           options="MultiLine"
           style="width: 100%; height: 100pt; padding: 10pt;
                  border: 1pt solid #cccccc; font-size: 10pt;" />
</div>

<div style="margin-top: 20pt;">
    <input type="checkbox" value="checked" style="width: 15pt; height: 15pt;" />
    <label style="margin-left: 8pt;">
        I certify that all information provided is accurate and complete.
    </label>
</div>

Horizontal Form Layout 

<style>
    .compact-form {
        border: 1pt solid #cccccc;
        padding: 15pt;
        background-color: #f9f9f9;
    }
    .form-field {
        display: inline-block;
        margin-right: 15pt;
        margin-bottom: 10pt;
        vertical-align: top;
    }
    .field-label {
        display: block;
        font-weight: bold;
        font-size: 9pt;
        color: #666666;
        margin-bottom: 4pt;
    }
    .field-input {
        padding: 6pt;
        border: 1pt solid #cccccc;
        font-size: 10pt;
        background-color: white;
    }
</style>

<div class="compact-form">
    <div class="form-field">
        <label class="field-label">First Name</label>
        <input type="text" value="John" class="field-input" style="width: 120pt;" />
    </div>

    <div class="form-field">
        <label class="field-label">Last Name</label>
        <input type="text" value="Doe" class="field-input" style="width: 120pt;" />
    </div>

    <div class="form-field">
        <label class="field-label">Date</label>
        <input type="text" value="01/15/2024" class="field-input" style="width: 100pt;" />
    </div>

    <div style="clear: both;"></div>

    <div class="form-field">
        <label class="field-label">Email</label>
        <input type="text" value="john.doe@example.com" class="field-input" style="width: 260pt;" />
    </div>

    <div class="form-field">
        <label class="field-label">Phone</label>
        <input type="text" value="(555) 123-4567" class="field-input" style="width: 120pt;" />
    </div>
</div>

Two-Column Form Layout 

<style>
    .two-column-form {
        width: 100%;
    }
    .form-column {
        display: inline-block;
        width: 48%;
        vertical-align: top;
        margin-right: 2%;
    }
    .form-group {
        margin-bottom: 15pt;
    }
    .group-label {
        display: block;
        font-weight: bold;
        margin-bottom: 5pt;
        color: #333333;
    }
    .group-input {
        width: 100%;
        padding: 8pt;
        border: 1pt solid #cccccc;
        border-radius: 3pt;
    }
</style>

<div class="two-column-form">
    <div class="form-column">
        <div class="form-group">
            <label class="group-label">First Name</label>
            <input type="text" value="John" class="group-input" />
        </div>

        <div class="form-group">
            <label class="group-label">Email</label>
            <input type="text" value="john@example.com" class="group-input" />
        </div>

        <div class="form-group">
            <label class="group-label">City</label>
            <input type="text" value="Chicago" class="group-input" />
        </div>
    </div>

    <div class="form-column">
        <div class="form-group">
            <label class="group-label">Last Name</label>
            <input type="text" value="Doe" class="group-input" />
        </div>

        <div class="form-group">
            <label class="group-label">Phone</label>
            <input type="text" value="(555) 123-4567" class="group-input" />
        </div>

        <div class="form-group">
            <label class="group-label">ZIP Code</label>
            <input type="text" value="60601" class="group-input" />
        </div>
    </div>
</div>

Password and File Input Fields 

<div style="margin-bottom: 15pt;">
    <label style="font-weight: bold; display: block; margin-bottom: 5pt;">
        Password:
    </label>
    <input type="password" value="secretpass123" options="Password"
           style="width: 250pt; padding: 8pt; border: 1pt solid #cccccc;
                  font-family: monospace;" />
    <p style="margin: 5pt 0 0 0; font-size: 9pt; color: #666666;">
        Note: Password displayed as entered (PDFs are static documents)
    </p>
</div>

<div style="margin-bottom: 15pt;">
    <label style="font-weight: bold; display: block; margin-bottom: 5pt;">
        Upload Document:
    </label>
    <input type="file" value="resume.pdf" options="File"
           style="width: 300pt; padding: 8pt; border: 1pt solid #cccccc;
                  background-color: #f5f5f5;" />
</div>

Dynamic Form with Data Binding 

<!-- Model: {
    user: {
        firstName: "Alice",
        lastName: "Johnson",
        email: "alice@example.com",
        preferences: {
            newsletter: true,
            notifications: true,
            marketing: false
        }
    }
} -->

<h2 style="color: #336699;">User Preferences</h2>

<div style="margin-bottom: 20pt; padding: 15pt; border: 1pt solid #e0e0e0;">
    <h3 style="margin-top: 0;">Personal Information</h3>

    <div style="margin-bottom: 10pt;">
        <label style="display: inline-block; width: 130pt; font-weight: bold;">
            First Name:
        </label>
        <input type="text" value=""
               style="width: 200pt; padding: 6pt; border: 1pt solid #cccccc;" />
    </div>

    <div style="margin-bottom: 10pt;">
        <label style="display: inline-block; width: 130pt; font-weight: bold;">
            Last Name:
        </label>
        <input type="text" value=""
               style="width: 200pt; padding: 6pt; border: 1pt solid #cccccc;" />
    </div>

    <div style="margin-bottom: 10pt;">
        <label style="display: inline-block; width: 130pt; font-weight: bold;">
            Email:
        </label>
        <input type="text" value=""
               style="width: 300pt; padding: 6pt; border: 1pt solid #cccccc;" />
    </div>
</div>

<div style="padding: 15pt; border: 1pt solid #e0e0e0;">
    <h3 style="margin-top: 0;">Communication Preferences</h3>

    <div style="margin-bottom: 10pt;">
        <input type="checkbox"
               value=""
               style="width: 15pt; height: 15pt;" />
        <label style="margin-left: 8pt;">Send me newsletter updates</label>
    </div>

    <div style="margin-bottom: 10pt;">
        <input type="checkbox"
               value=""
               style="width: 15pt; height: 15pt;" />
        <label style="margin-left: 8pt;">Enable push notifications</label>
    </div>

    <div style="margin-bottom: 10pt;">
        <input type="checkbox"
               value=""
               style="width: 15pt; height: 15pt;" />
        <label style="margin-left: 8pt;">Receive marketing emails</label>
    </div>
</div>

Form Template with Repeating Fields 

<!-- Model: {
    contacts: [
        {name: "John Doe", email: "john@example.com", phone: "(555) 111-1111"},
        {name: "Jane Smith", email: "jane@example.com", phone: "(555) 222-2222"}
    ]
} -->

<h2 style="color: #336699;">Contact List</h2>

<template data-bind="">
    <div style="margin-bottom: 15pt; padding: 12pt;
                border: 1pt solid #e0e0e0; background-color: #f9f9f9;">
        <div style="margin-bottom: 8pt;">
            <label style="display: inline-block; width: 100pt; font-weight: bold;">
                Name:
            </label>
            <input type="text" value=""
                   style="width: 250pt; padding: 6pt; border: 1pt solid #cccccc;" />
        </div>

        <div style="margin-bottom: 8pt;">
            <label style="display: inline-block; width: 100pt; font-weight: bold;">
                Email:
            </label>
            <input type="text" value=""
                   style="width: 250pt; padding: 6pt; border: 1pt solid #cccccc;" />
        </div>

        <div style="margin-bottom: 8pt;">
            <label style="display: inline-block; width: 100pt; font-weight: bold;">
                Phone:
            </label>
            <input type="text" value=""
                   style="width: 200pt; padding: 6pt; border: 1pt solid #cccccc;" />
        </div>
    </div>
</template>

Professional Medical Form 

<style>
    .medical-form {
        font-size: 10pt;
    }
    .section-header {
        background-color: #2c5f8d;
        color: white;
        padding: 10pt;
        margin: 15pt 0 10pt 0;
        font-weight: bold;
    }
    .form-field-row {
        margin-bottom: 10pt;
    }
    .field-label-wide {
        display: inline-block;
        width: 180pt;
        font-weight: bold;
    }
    .medical-input {
        padding: 6pt;
        border: 1pt solid #999999;
        background-color: white;
    }
</style>

<div class="medical-form">
    <h1 style="text-align: center; color: #2c5f8d;">PATIENT INTAKE FORM</h1>

    <div class="section-header">Patient Information</div>

    <div class="form-field-row">
        <label class="field-label-wide">Patient Name:</label>
        <input type="text" value="Robert Johnson" class="medical-input" style="width: 280pt;" />
    </div>

    <div class="form-field-row">
        <label class="field-label-wide">Date of Birth:</label>
        <input type="text" value="03/22/1975" class="medical-input" style="width: 120pt;" />
        <label style="margin-left: 20pt; margin-right: 10pt; font-weight: bold;">Age:</label>
        <input type="text" value="48" class="medical-input" style="width: 60pt;" />
    </div>

    <div class="form-field-row">
        <label class="field-label-wide">Emergency Contact:</label>
        <input type="text" value="Mary Johnson" class="medical-input" style="width: 200pt;" />
        <label style="margin-left: 10pt; margin-right: 5pt; font-weight: bold;">Phone:</label>
        <input type="text" value="(555) 999-8888" class="medical-input" style="width: 120pt;" />
    </div>

    <div class="section-header">Medical History</div>

    <div style="margin-bottom: 10pt;">
        <label style="font-weight: bold; display: block; margin-bottom: 6pt;">
            Do you have any of the following conditions? (Check all that apply)
        </label>

        <div style="margin-left: 15pt;">
            <div style="display: inline-block; width: 48%; margin-bottom: 6pt;">
                <input type="checkbox" value="" style="width: 12pt; height: 12pt;" />
                <label style="margin-left: 6pt;">Diabetes</label>
            </div>
            <div style="display: inline-block; width: 48%; margin-bottom: 6pt;">
                <input type="checkbox" value="checked" style="width: 12pt; height: 12pt;" />
                <label style="margin-left: 6pt;">High Blood Pressure</label>
            </div>

            <div style="display: inline-block; width: 48%; margin-bottom: 6pt;">
                <input type="checkbox" value="" style="width: 12pt; height: 12pt;" />
                <label style="margin-left: 6pt;">Heart Disease</label>
            </div>
            <div style="display: inline-block; width: 48%; margin-bottom: 6pt;">
                <input type="checkbox" value="" style="width: 12pt; height: 12pt;" />
                <label style="margin-left: 6pt;">Asthma</label>
            </div>

            <div style="display: inline-block; width: 48%; margin-bottom: 6pt;">
                <input type="checkbox" value="checked" style="width: 12pt; height: 12pt;" />
                <label style="margin-left: 6pt;">Allergies</label>
            </div>
            <div style="display: inline-block; width: 48%; margin-bottom: 6pt;">
                <input type="checkbox" value="" style="width: 12pt; height: 12pt;" />
                <label style="margin-left: 6pt;">None</label>
            </div>
        </div>
    </div>

    <div style="margin-bottom: 10pt;">
        <label style="font-weight: bold; display: block; margin-bottom: 5pt;">
            Current Medications:
        </label>
        <input type="text"
               value="Lisinopril 10mg daily&#10;Aspirin 81mg daily"
               options="MultiLine"
               style="width: 100%; height: 60pt; padding: 8pt;
                      border: 1pt solid #999999; font-size: 10pt;" />
    </div>

    <div style="margin-bottom: 10pt;">
        <label style="font-weight: bold; display: block; margin-bottom: 5pt;">
            Reason for Visit:
        </label>
        <input type="text"
               value="Annual physical examination and blood pressure follow-up"
               options="MultiLine"
               style="width: 100%; height: 60pt; padding: 8pt;
                      border: 1pt solid #999999; font-size: 10pt;" />
    </div>

    <div style="margin-top: 20pt; padding-top: 15pt; border-top: 1pt solid #cccccc;">
        <input type="checkbox" value="checked" style="width: 12pt; height: 12pt;" />
        <label style="margin-left: 8pt; font-weight: bold;">
            I certify that the above information is accurate to the best of my knowledge.
        </label>
    </div>
</div>

See Also

  • label - Label element for form fields
  • fieldset - Fieldset and legend for grouping form elements
  • form - Form container element
  • div - Generic block container
  • span - Inline container for styling
  • Data Binding - Dynamic data binding and expressions
  • CSS Styles - Complete CSS styling reference