nginx-proxy-manager/src/frontend/js/app/nginx/proxy/form.ejs

<div class="modal-content">
    <div class="modal-header">
        <h5 class="modal-title"><%- i18n('proxy-hosts', 'form-title', {id: id}) %></h5>
        <button type="button" class="close cancel" aria-label="Close" data-dismiss="modal">&nbsp;</button>
    </div>
    <div class="modal-body has-tabs">
        <form>
            <ul class="nav nav-tabs" role="tablist">
                <li role="presentation" class="nav-item"><a href="#details" aria-controls="tab1" role="tab" data-toggle="tab" class="nav-link active"><i class="fe fe-zap"></i> <%- i18n('all-hosts', 'details') %></a></li>
                <li role="presentation" class="nav-item"><a href="#ssl-options" aria-controls="tab2" role="tab" data-toggle="tab" class="nav-link"><i class="fe fe-shield"></i> <%- i18n('str', 'ssl') %></a></li>
                <li role="presentation" class="nav-item"><a href="#advanced" aria-controls="tab3" role="tab" data-toggle="tab" class="nav-link"><i class="fe fe-settings"></i> <%- i18n('all-hosts', 'advanced') %></a></li>
            </ul>
            <div class="tab-content">
                <!-- Details -->
                <div role="tabpanel" class="tab-pane active" id="details">
                    <div class="row">
                        <div class="col-sm-12 col-md-12">
                            <div class="form-group">
                                <label class="form-label"><%- i18n('all-hosts', 'domain-names') %> <span class="form-required">*</span></label>
                                <input type="text" name="domain_names" class="form-control" id="input-domains" value="<%- domain_names.join(',') %>" required>
                            </div>
                        </div>
                        <div class="col-sm-3 col-md-3">
                            <div class="form-group">
                                <label class="form-label"><%- i18n('proxy-hosts', 'forward-scheme') %><span class="form-required">*</span></label>
                                <select name="forward_scheme" class="form-control custom-select" placeholder="http">
                                    <option value="http" <%- forward_scheme === 'http' ? 'selected' : '' %>>http</option>
                                    <option value="https" <%- forward_scheme === 'https' ? 'selected' : '' %>>https</option>
                                </select>
                            </div>
                        </div>
                        <div class="col-sm-5 col-md-5">
                            <div class="form-group">
                                <label class="form-label"><%- i18n('proxy-hosts', 'forward-host') %><span class="form-required">*</span></label>
                                <input type="text" name="forward_host" class="form-control text-monospace" placeholder="" value="<%- forward_host %>" autocomplete="off" maxlength="50" required>
                            </div>
                        </div>
                        <div class="col-sm-4 col-md-4">
                            <div class="form-group">
                                <label class="form-label"><%- i18n('proxy-hosts', 'forward-port') %> <span class="form-required">*</span></label>
                                <input name="forward_port" type="number" class="form-control text-monospace" placeholder="80" value="<%- forward_port %>" required>
                            </div>
                        </div>
                        <div class="col-sm-6 col-md-6">
                            <div class="form-group">
                                <label class="custom-switch">
                                    <input type="checkbox" class="custom-switch-input" name="caching_enabled" value="1"<%- caching_enabled ? ' checked' : '' %>>
                                    <span class="custom-switch-indicator"></span>
                                    <span class="custom-switch-description"><%- i18n('all-hosts', 'caching-enabled') %></span>
                                </label>
                            </div>
                        </div>
                        <div class="col-sm-6 col-md-6">
                            <div class="form-group">
                                <label class="custom-switch">
                                    <input type="checkbox" class="custom-switch-input" name="block_exploits" value="1"<%- block_exploits ? ' checked' : '' %>>
                                    <span class="custom-switch-indicator"></span>
                                    <span class="custom-switch-description"><%- i18n('all-hosts', 'block-exploits') %></span>
                                </label>
                            </div>
                        </div>
                        <div class="col-sm-12 col-md-12">
                            <div class="form-group">
                                <label class="custom-switch">
                                    <input type="checkbox" class="custom-switch-input" name="allow_websocket_upgrade" value="1"<%- allow_websocket_upgrade ? ' checked' : '' %>>
                                    <span class="custom-switch-indicator"></span>
                                    <span class="custom-switch-description"><%- i18n('proxy-hosts', 'allow-websocket-upgrade') %></span>
                                </label>
                            </div>
                        </div>

                        <div class="col-sm-12 col-md-12">
                            <div class="form-group">
                                <label class="form-label"><%- i18n('proxy-hosts', 'access-list') %></label>
                                <select name="access_list_id" class="form-control custom-select" placeholder="<%- i18n('access-lists', 'public') %>">
                                    <option selected value="0" data-data="{&quot;id&quot;:0}" <%- access_list_id ? '' : 'selected' %>><%- i18n('access-lists', 'public') %></option>
                                </select>
                            </div>
                        </div>
                    </div>
                </div>

                <!-- SSL -->
                <div role="tabpanel" class="tab-pane" id="ssl-options">
                    <div class="row">
                        <div class="col-sm-12 col-md-12">
                            <div class="form-group">
                                <label class="form-label"><%- i18n('all-hosts', 'ssl-certificate') %></label>
                                <select name="certificate_id" class="form-control custom-select" placeholder="<%- i18n('all-hosts', 'none') %>">
                                    <option selected value="0" data-data="{&quot;id&quot;:0}" <%- certificate_id ? '' : 'selected' %>><%- i18n('all-hosts', 'none') %></option>
                                    <option selected value="new" data-data="{&quot;id&quot;:&quot;new&quot;}"><%- i18n('all-hosts', 'new-cert') %></option>
                                </select>
                            </div>
                        </div>
                        <div class="col-sm-6 col-md-6">
                            <div class="form-group">
                                <label class="custom-switch">
                                    <input type="checkbox" class="custom-switch-input" name="ssl_forced" value="1"<%- ssl_forced ? ' checked' : '' %><%- certificate_id ? '' : ' disabled' %>>
                                    <span class="custom-switch-indicator"></span>
                                    <span class="custom-switch-description"><%- i18n('all-hosts', 'force-ssl') %></span>
                                </label>
                            </div>
                        </div>
                        <div class="col-sm-6 col-md-6">
                            <div class="form-group">
                                <label class="custom-switch">
                                    <input type="checkbox" class="custom-switch-input" name="http2_support" value="1"<%- http2_support ? ' checked' : '' %><%- certificate_id ? '' : ' disabled' %>>
                                    <span class="custom-switch-indicator"></span>
                                    <span class="custom-switch-description"><%- i18n('all-hosts', 'http2-support') %></span>
                                </label>
                            </div>
                        </div>

                        <!-- Lets encrypt -->
                        <div class="col-sm-12 col-md-12 letsencrypt">
                            <div class="form-group">
                                <label class="form-label"><%- i18n('ssl', 'letsencrypt-email') %> <span class="form-required">*</span></label>
                                <input name="meta[letsencrypt_email]" type="email" class="form-control" placeholder="" value="<%- getLetsencryptEmail() %>" required disabled>
                            </div>
                        </div>
                        <div class="col-sm-12 col-md-12 letsencrypt">
                            <div class="form-group">
                                <label class="custom-switch">
                                    <input type="checkbox" class="custom-switch-input" name="meta[letsencrypt_agree]" value="1" required disabled>
                                    <span class="custom-switch-indicator"></span>
                                    <span class="custom-switch-description"><%= i18n('ssl', 'letsencrypt-agree', {url: 'https://letsencrypt.org/repository/'}) %> <span class="form-required">*</span></span>
                                </label>
                            </div>
                        </div>
                    </div>
                </div>

                <!-- Advanced -->
                <div role="tabpanel" class="tab-pane" id="advanced">
                    <div class="row">
                        <div class="col-md-12">
                            <div class="form-group mb-0">
                                <label class="form-label"><%- i18n('all-hosts', 'advanced-config') %></label>
                                <textarea name="advanced_config" rows="8" class="form-control text-monospace" placeholder="# <%- i18n('all-hosts', 'advanced-warning') %>"><%- advanced_config %></textarea>
                            </div>
                        </div>
                    </div>
                </div>
            </div>
        </form>
    </div>
    <div class="modal-footer">
        <button type="button" class="btn btn-secondary cancel" data-dismiss="modal"><%- i18n('str', 'cancel') %></button>
        <button type="button" class="btn btn-teal save"><%- i18n('str', 'save') %></button>
    </div>
</div>