"LocalSymptons"
Bootstrap 3.2.0 Snippet by mcrayne

<link href="//netdna.bootstrapcdn.com/bootstrap/3.2.0/css/bootstrap.min.css" rel="stylesheet" id="bootstrap-css"> <script src="//netdna.bootstrapcdn.com/bootstrap/3.2.0/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> <div class="container"> <!-- Form Name --> <legend>Local Diary Card</legend> <!-- Appended Input--> <div class="form-group"> <label class="col-md-4 control-label" for="swelling">Swelling</label> <div class="col-md-3"> <div class="input-group"> <input id="swelling" name="swelling" class="form-control" placeholder="swelling" type="text"> <span class="input-group-addon">mm</span> </div> </div> </div> <!-- Appended Input--> <div class="form-group"> <label class="col-md-4 control-label" for="redness">Redness</label> <div class="col-md-3"> <div class="input-group"> <input id="redness" name="redness" class="form-control" placeholder="Swelling" type="text"> <span class="input-group-addon">mm</span> </div> </div> </div> <!-- Select Basic --> <div class="form-group"> <label class="col-md-4 control-label" for="pain">Pain</label> <div class="col-md-3"> <select id="pain" name="pain" class="form-control"> <option value="1">Minor</option> <option value="2">Mild</option> <option value="3">Pretty Bad</option> <option value="4">Really Bad</option> </select> </div> </div> </fieldset> </form> </div> <!-- container -->

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