diff --git a/app/Forms/AskSubmitForm.php b/app/Forms/AskSubmitForm.php
index 70aed29..33d186c 100755
--- a/app/Forms/AskSubmitForm.php
+++ b/app/Forms/AskSubmitForm.php
@@ -15,9 +15,26 @@ class AskSubmitForm extends Form
         $this->add("visit", Field::TEXT, ["label" => "拜访人员", "rules" => "required"]);
         $this->add("date", Field::DATE, ["label" => "考核日期", "rules" => "required"]);
         $this->add("department", Field::TEXT, ["label" => "科室", "rules" => "required"]);
-        $this->add("ask[]", Field::NUMBER, ["label" => "遵守医院各项规章制度，维持秩序。","rules" => "required",'attr' => ['placeholder' => 'Enter text here...']]);
-
-
+        $this->add("ask[]", Field::NUMBER, ["label" => "遵守医院各项规章制度，维持秩序。",
+            "rules" => "required",
+            'attr' => ['placeholder' => '18-20分满意，15-17分较满意，14分及以下不满意']
+        ]);
+        $this->add("ask[]", Field::NUMBER, ["label" => "接受医师、护士指导，并认真正确执行。",
+            "rules" => "required",
+            'attr' => ['placeholder' => '18-20分满意，15-17分较满意，14分及以下不满意']
+        ]);
+        $this->add("ask[]", Field::NUMBER, ["label" => "保持床单元及周围环境清洁整齐，节约水电，不损坏公物。",
+            "rules" => "required",
+            'attr' => ['placeholder' => '18-20分满意，15-17分较满意，14分及以下不满意']
+        ]);
+        $this->add("ask[]", Field::NUMBER, ["label" => "交接班、查房时间段在岗，并且手机、电视机保持静音。",
+            "rules" => "required",
+            'attr' => ['placeholder' => '18-20分满意，15-17分较满意，14分及以下不满意']
+        ]);
+        $this->add("ask[]", Field::NUMBER, ["label" => "公司管理人员对陪护工作管理及持续改进。",
+            "rules" => "required",
+            'attr' => ['placeholder' => '18-20分满意，15-17分较满意，14分及以下不满意']
+        ]);
         $this->add("tip", Field::TEXTAREA, ["label" => "建议"]);
         $this->add('buttons', 'buttongroup', ["splitted" => true, "buttons" => [
             ["label" => "保存", "attr" => ["class" => "btn btn-primary mr-1", "type" => "submit"]],