daggerheart/templates/dialogs/riskItAllDialog.hbs

<div>
    <header class="dialog-header">
        <h1>{{title}}</h1>
    </header>
    <div>
        <span>Remaining points to use here.</span>
    </div>
    <div class="risk-it-all-container">
        <div class="two-columns even">
            <span>{{currentHitPointsLabel}}</span>
            <div>
                <span>New Hit Points Value</span>
                <input type="text" data-dtype="Number" name="newHitPoints" value="{{newHitPoints}}" />
            </div>

            <span>{{currentStressLabel}}</span>
            <div>
                <span>New Stress Value</span>
                <input type="text" data-dtype="Number" name="newStress" value="{{newStress}}" />
            </div>
        </div>
    </div>
    <footer class="flexrow">
        <button data-action="close">
            <span>{{localize "Cancel"}}</span>
        </button>
        <button data-action="submit" {{#if (not this.validChoices)}}disabled{{/if}}>
            <span>
                {{localize "DAGGERHEART.APPLICATIONS.RiskItAllDialog.submit"}}
            </span>
        </button>
    </footer>
</div>