"EMS Form"
Bootstrap 3.3.0 Snippet by coolnam

<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 ----------> <form class="form-horizontal"> <fieldset> <!-- Form Name --> <legend>EMS Form</legend> <!-- Select Basic --> <div class="form-group"> <label class="col-md-4 control-label" for="selectbasic">1 Lying to Sitting</label> <div class="col-md-4"> <select id="selectbasic" name="selectbasic" class="form-control"> <option value="2">2 Independent</option> <option value="1">1 Needs help of 1 person</option> <option value="0">0 Needs help of 2+ people</option> </select> </div> </div> <!-- Select Basic --> <div class="form-group"> <label class="col-md-4 control-label" for="selectbasic">2 Sitting to Lying</label> <div class="col-md-4"> <select id="selectbasic" name="selectbasic" class="form-control"> <option value="0">2 Independent</option> <option value="1">1 Needs help of 1 person</option> <option value="2">0 Needs help of 2+ people</option> </select> </div> </div> <!-- Button --> <div class="form-group"> <label class="col-md-4 control-label" for="btnCal"></label> <div class="col-md-4"> <button id="btnCal" name="btnCal" class="btn btn-primary">Save</button> </div> </div> </fieldset> </form>

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