prediction

<!DOCTYPE html>

<html>

<head>

<title></title>

</head>

<body>

<form>

<table align="center">

<th colspan="2">Contact us</th>

<tr>

<td>First Name:</td>

<td><input type="text" name="firstname" id="firstname" required></td>

</tr>

<tr>

<td>Last Name:</td>

<td><input type="text" name="lastname" id="lastname" required></td>

</tr>

<tr>

<td>Date Of Birth:</td>

<td><input type="date" name="dateofbirth" id="dateofbirth" required></td>

</tr>

<tr>

<td>Time Of Birth:</td>

<td><input type="time" name="timeofbirth" id="timeofbirth" required></td>

</tr>

<tr>

<td>Place Of Birth:</td>

<td><input type="text" name="placeofbirth" id="placeofbirth" required></td>

</tr>

<tr>

<td>Mobile Number:</td>

<td><input type="number" name="mobilenumber" id="mobilenumber" required></td>

</tr>

<tr>

<td>Occupatation:</td>

<td><input type="radio" name="occupation" id="Work" required> Work <input type="radio" name="occupation" id="Business" required> Business</td>

</tr>

<tr>

<td>Marital Status:</td>

<td><input type="radio" name="status" id="single" required> Single <input type="radio" name="status" id="married" required> Married <input type="radio" name="status" id="divorced" required> Divorced</td>

</tr>

<tr>

<td>E-mail:</td>

<td><input type="email" name="email" id="email" required></td>

</tr>

<tr>

<td>Consultation Catagory:</td>

<td><select id="consultationcategory" name="consultationcategory" required>

    <option disabled selected value> -- select an option -- </option>

    <option value="careerandbusiness">Career & Business</option>

    <option value="geneticconsultation">Genetic Consultation</option>

    <option value="health">Health</option>

    <option value="horoscopematching">Horoscope Matching</option>

    <option value="legalissue">Legal Issues</option>

    <option value="loveandrelationship">Love & Relationship</option>

    <option value="marriageobstacles">Marriage Obstacles</option>

    <option value="personalandconfidencial">Personal & Confidencial</option>

    <option value="travel">Travel</option>

    <option value="wealthandproperty">Wealth & Property</option>

    <option value="completeanalysis">Complete Analysis</option>

  </select></td>

</tr>

<tr>

<td>Payment:</td>

<td>PAYPAL</td>

</tr>

<tr>

<td><input type="submit" name="submit" id="button"></td>

<td><input type="reset" name="reset" id="button"></td>

</tr>

</table>

</form>

</body>

</html>