<link href="//maxcdn.bootstrapcdn.com/bootstrap/3.3.0/css/bootstrap.min.css" rel="stylesheet" id="bootstrap-css"> <script src="//maxcdn.bootstrapcdn.com/bootstrap/3.3.0/js/bootstrap.min.js"></script> <script src="//code.jquery.com/jquery-1.11.1.min.js"></script> <!------ Include the above in your HEAD tag ----------> <div id="fullscreen_bg" class="fullscreen_bg"/> <form class="form-signin"> <div class="container"> <div class="row"> <div class="col-md-4 col-md-offset-4"> <div class="panel panel-default"> <div class="panel-body"> <h3 class="text-center"> Add New Patient </h3> <form class="form form-signup" role="form"> <div class="form-group"> <div class="input-group"> <span class="input-group-addon"><span class="glyphicon glyphicon-pencil"></span> </span> <input type="text" class="form-control" placeholder="Name" /> </div> </div> <div class="form-group"> <div class="input-group"> <span class="input-group-addon"><span class="glyphicon glyphicon-th"></span></span> <input type="Text" class="form-control" placeholder="Age" /> </div> </div> <div class="form-group"> <div class="input-group"> <span class="input-group-addon"><span class="glyphicon glyphicon-calendar"></span></span> <input type="date" class="form-control" placeholder="Date of Birth" /> </div> </div> <div class="form-group"> <div class="input-group"> <span class="input-group-addon"><span class="glyphicon glyphicon-home"></span></span> <input type="Text" class="form-control" placeholder="Address" /> </div> </div> <div class="form-group"> <div class="input-group"> <span class="input-group-addon"><span class="glyphicon glyphicon-phone"></span></span> <input type="Text" class="form-control" placeholder="Telephone" /> </div> </div> <div class="form-group"> <div class="input-group"> <span class="input-group-addon"><span class="glyphicon glyphicon-usd"></span></span> <input type="password" class="form-control" placeholder="Job" /> </div> </div> <div class="form-group"> <div class="input-group"> <span class="input-group-addon"><span class="glyphicon glyphicon-heart"></span></span> <input type="password" class="form-control" placeholder="Martial Status" /> </div> </div> <div class="form-group"> <div class="input-group"> <span class="input-group-addon"><span class="glyphicon glyphicon-usd"></span></span> <input type="password" class="form-control" placeholder="Gender" /> </div> </div> </div> <a href="http://www.jquery2dotnet.com" class="btn btn-sm btn-primary" role="button" style="width:130px" > Submit</a> </form> <a href="http://www.jquery2dotnet.com" class="btn btn-sm btn-primary " role="button" style="width:130px" > HomePage</a> </form> </div> </div> </div> </div> </form> </div>

body { background-color: #1b1b1b; padding-top: 40px; } .form-signin { max-width: 280px; padding: 15px; margin-left:200px; margin-top:70px; } .input-group-addon { background-color: rgb(50, 118, 177); border-color: rgb(40, 94, 142); color: rgb(255, 255, 255); } .form-control:focus { background-color: rgb(50, 118, 177); border-color: rgb(40, 94, 142); color: rgb(255, 255, 255); } .form-signup input[type="text"],.form-signup input[type="password"] { border: 1px solid rgb(50, 118, 177); } .fullscreen_bg { position: fixed; top: 0; right: 0; bottom: 0; left: 0; background-size: cover; background-position: 50% 50%; background-image: url('http://i.imgur.com/aFs5QmP.jpg'); background-repeat:repeat; }