<!DOCTYPE html>
<html>
<head>
<base target="_top">
<link rel="stylesheet" href="https://maxcdn.bootstrapcdn.com/bootstrap/4.0.0/css/bootstrap.min.css" integrity="sha384-Gn5384xqQ1aoWXA+058RXPxPg6fy4IWvTNh0E263XmFcJlSAwiGgFAW/dAiS6JXm" crossorigin="anonymous">
</head>
<body>
<div class="container">
<div class="row">
<div class="col-6">
<form id="myForm" onsubmit="handleFormSubmit(this)">
<p class="h4 mb-4 text-center">Contact Details</p>
<div class="form-row">
<div class="form-group col-md-6">
<label for="first_name">First Name</label>
<input type="text" class="form-control" id="first_name" name="first_name" placeholder="First Name">
</div>
<div class="form-group col-md-6">
<label for="last_name">Last Name</label>
<input type="text" class="form-control" id="last_name" name="last_name" placeholder="Last Name">
</div>
</div>
<div class="form-row">
<div class="form-group col-md-6">
<p>Gender</p>
<div class="form-check form-check-inline">
<input class="form-check-input" type="radio" name="gender" id="male" value="male">
<label class="form-check-label" for="male">Male</label>
</div>
<div class="form-check form-check-inline">
<input class="form-check-input" type="radio" name="gender" id="female" value="female">
<label class="form-check-label" for="female">Female</label>
</div>
</div>
<div class="form-group col-md-6">
<label for="dateOfBirth">Date of Birth</label>
<input type="date" class="form-control" id="dateOfBirth" name="dateOfBirth">
</div>
</div>
<div class="form-group">
<label for="email">Email</label>
<input type="email" class="form-control" id="email" name="email" placeholder="Email">
</div>
<div class="form-group">
<label for="phone">Phone Number</label>
<input type="tel" class="form-control" id="phone" name="phone" placeholder="Phone Number">
</div>
<button type="submit" class="btn btn-primary btn-block">Submit</button>
</form>
<div id="output"></div>
</div>
</div>
</div>
</body>
</html>
