<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>FichaMedica</legend> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="txtCodigo">Codigo</label> <div class="col-md-2"> <input id="txtCodigo" name="txtCodigo" type="text" placeholder="" class="form-control input-md"> </div> </div> <!-- Select Basic --> <div class="form-group"> <label class="col-md-4 control-label" for="cmbSexo">Sexo</label> <div class="col-md-2"> <select id="cmbSexo" name="cmbSexo" class="form-control"> <option value="1">Masc</option> <option value="2">Fem</option> </select> </div> </div> <!-- Select Basic --> <div class="form-group"> <label class="col-md-4 control-label" for="cmbCort">Cor/Etinia</label> <div class="col-md-4"> <select id="cmbCort" name="cmbCort" class="form-control"> <option value="1">Branca</option> <option value="2">Negra</option> <option value="3">Parda</option> <option value="4">Amarela</option> <option value="5">Indigena</option> <option value="6">Albina</option> <option value="7">Outras</option> </select> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="txtNascimento">Nascimento</label> <div class="col-md-4"> <input id="txtNascimento" name="txtNascimento" type="text" placeholder="" class="form-control input-md" required=""> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="textinput">Paciente</label> <div class="col-md-8"> <input id="textinput" name="textinput" type="text" placeholder="" class="form-control input-md" required=""> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="txtEndereco">Endereço</label> <div class="col-md-8"> <input id="txtEndereco" name="txtEndereco" type="text" placeholder="ex...: Rua 1, 000 - Centro" class="form-control input-md" required=""> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="txtCidade">Cidade/Uf</label> <div class="col-md-5"> <input id="txtCidade" name="txtCidade" type="text" placeholder="ex...: Fernandopolis, SP" class="form-control input-md" required=""> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="txtNaturalidade">Naturalidade</label> <div class="col-md-4"> <input id="txtNaturalidade" name="txtNaturalidade" type="text" placeholder="" class="form-control input-md"> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="txtNacionalidade">Nacionalidade</label> <div class="col-md-4"> <input id="txtNacionalidade" name="txtNacionalidade" type="text" placeholder="" class="form-control input-md"> </div> </div> <!-- Select Basic --> <div class="form-group"> <label class="col-md-4 control-label" for="cmbEstadoCivil">Estado Civil</label> <div class="col-md-4"> <select id="cmbEstadoCivil" name="cmbEstadoCivil" class="form-control"> <option value="1">Solteiro(a)</option> <option value="2">Casado(a)</option> <option value="3">Separado(a)</option> <option value="4">Divorciado(a)</option> <option value="5">Viuvo(a)</option> </select> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="txtConjuge">Conjuge/Acompanhante</label> <div class="col-md-5"> <input id="txtConjuge" name="txtConjuge" type="text" placeholder="" class="form-control input-md"> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="txtProfissao">Profissão</label> <div class="col-md-4"> <input id="txtProfissao" name="txtProfissao" type="text" placeholder="" class="form-control input-md"> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="txtClasse">Classe</label> <div class="col-md-4"> <input id="txtClasse" name="txtClasse" type="text" placeholder="" class="form-control input-md"> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="txtCarteira">Carteirinha</label> <div class="col-md-4"> <input id="txtCarteira" name="txtCarteira" type="text" placeholder="" class="form-control input-md"> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="txtFone1">Telefones</label> <div class="col-md-4"> <input id="txtFone1" name="txtFone1" type="text" placeholder="" class="form-control input-md"> </div> </div> </fieldset> </form>