<form>
<p>How did you find out about us?</p>
<label><input name="origin" type="radio" value="google" checked> Google</label>
<label><input name="origin" type="radio" value="facebook"> Facebook</label>
<p>Please agree to our terms:</p>
<label><input name="newsletter" type="checkbox" checked> I want to subscribe to a personalized newsletter.</label>
<label><input name="privacy" type="checkbox"> I have read and I agree to the Privacy Policy.</label>
<input type="submit" value="Submit form">
</form>