<link href="//netdna.bootstrapcdn.com/bootstrap/3.1.0/css/bootstrap.min.css" rel="stylesheet" id="bootstrap-css">
<script src="//netdna.bootstrapcdn.com/bootstrap/3.1.0/js/bootstrap.min.js"></script>
<script src="//code.jquery.com/jquery-1.11.1.min.js"></script>
<form class="form-horizontal">
<fieldset>
<legend>System User Registration</legend>
<div class="control-group">
<label class="control-label" for="national_id">National ID</label>
<div class="controls">
<input id="national_id" name="national_id" placeholder="National ID" class="input-medium" required="" type="text">
</div>
</div>
<div class="control-group">
<label class="control-label" for="name">Name</label>
<div class="controls">
<input id="name" name="name" placeholder="Please provide your name" class="input-medium" required="" type="text">
</div>
</div>
<div class="control-group">
<label class="control-label" for="professional_id">Clinician/ Professional ID(Optional)</label>
<div class="controls">
<input id="professional_id" name="professional_id" placeholder="" class="input-medium" type="text">
</div>
</div>
