<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>
<link rel="stylesheet" href="https://formden.com/static/cdn/bootstrap-iso.css" />
<style>.bootstrap-iso .formden_header h2, .bootstrap-iso .formden_header p, .bootstrap-iso form{font-family: Arial, Helvetica, sans-serif; color: black}.bootstrap-iso form button, .bootstrap-iso form button:hover{color: white !important;} .asteriskField{color: red;}</style>
<div class="bootstrap-iso">
<div class="container-fluid">
<div class="row">
<div class="col-md-6 col-sm-6 col-xs-12">
<form method="post">
<div class="form-group ">
<label class="control-label requiredField" for="name">
Medication
<span class="asteriskField">
*
</span>
</label>
<input class="form-control" id="name" name="name" placeholder="panadol etc." type="text"/>
<span class="help-block" id="hint_name">
what medication is required
</span>
</div>
<div class="form-group" id="div_checkbox1">
<label class="control-label " for="checkbox1">
Check all that apply
</label>
<div class=" ">
<label class="checkbox-inline">
<input name="checkbox1" type="checkbox" value="Taken as Needed"/>
Taken as Needed
</label>
<label class="checkbox-inline">
