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Bootstrap 3.3.0 Snippet by kebafall

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<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 ----------> <body> <div id="header"> <h1 style="color:white;background-color:#4959e9;">Nouvelle saisie de prestation</h1> </div> <div id="section"> <div class="form-group"> <label class="col-md-3 control-label" for="textinput">ID Prestation</label> <div class="col-md-8"> <input id="textinput" name="textinput" type="text" placeholder="123-456-789" class="form-control input-md"> </div> </div> <BR></BR> <div class="form-group"> <label class="col-md-3 control-label" for="textinput">Numero Patient</label> <div class="col-md-8"> <input id="textinput" name="textinput" type="text" placeholder="123-456-789" class="form-control input-md"> </div> </div> <BR></BR> <div class="form-group"> <label class="col-md-3 control-label" for="textinput">Nom</label> <div class="col-md-8"> <input id="textinput" name="textinput" type="text" placeholder="Adama" class="form-control input-md"> </div> </div> <BR></BR> <div class="form-group"> <label class="col-md-3 control-label" for="textinput">Prènom</label> <div class="col-md-8"> <input id="textinput" name="textinput" type="text" placeholder="DIAGNE" class="form-control input-md"> </div> </div> <BR></BR> <div class="form-group"> <label class="col-md-3 control-label" for="textinput">Date de naissance</label> <div class="col-md-3"> <input id="textinput" name="textinput" type="text" placeholder="25/07/1985" class="form-control input-md"> </div> </div> <BR></BR> <div class="form-group"> <label class="col-md-3 control-label" for="textinput">Symptomes</label> <div class="col-md-3"> <input id="textinput" name="textinput" type="text" placeholder="Rougeur, Fievre" class="form-control input-md"> </div> </div> <BR></BR> <!-- Select Basic --> <div class="form-group"> <label class="col-md-3 control-label" for="selectbasic">Pathologie</label> <div class="col-md-4"> <select id="selectbasic" name="selectbasic" class="form-control"> <option value="1">Paludisme</option> <option value="2">Diabéte Type 1</option> <option value="2">Diabéte Type 2</option> </select> </div> </div> <BR></BR> <!-- Button --> <div class="form-group" > <label class="col-md-3 control-label" for="singlebutton"></label> <div class="col-md-4"> <button id="singlebutton" name="singlebutton" class="btn btn-primary">Suivant</button> </div> </div> </div> <div id="footer" align="Left"> Copyright © DIGICONSEIL </div> </body>
<style> #header { color:white background-color:#4959e9; color:white; text-align:right; padding:5px; } #nav { line-height:30px; background-color:#eeeeee; height:300px; width:100px; float:left; padding:5px; } #section { width:40%; float:left; padding:10px; } #footer { background-color:#4959e9; color:white; clear:both; text-align:left; padding:5px; } </style>

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