<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> <!------ Include the above in your HEAD tag ----------> <form class="form-horizontal"> <fieldset> <!-- Form Name --> <legend>System User Registration</legend> <!-- Text input--> <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> <!-- Text input--> <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> <!-- Text input--> <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> <!-- Text input--> <div class="control-group"> <label class="control-label" for="email">Email</label> <div class="controls"> <input id="email" name="email" placeholder="e-mail" class="input-medium" type="text"> </div> </div> <!-- Select Basic --> <div class="control-group"> <label class="control-label" for="partner_name">Partner</label> <div class="controls"> <select id="partner_name" name="partner_name" class="input-medium"> <option>IRDO</option> <option>University of Manitoba</option> </select> </div> </div> <!-- Text input--> <div class="control-group"> <label class="control-label" for="d_o_b">Date of Birth</label> <div class="controls"> <input id="d_o_b" name="d_o_b" placeholder="Date of Birth (YYYY-MM-DD)" class="input-medium" required="" type="text"> </div> </div> <!-- Password input--> <div class="control-group"> <label class="control-label" for="password">Password</label> <div class="controls"> <input id="password" name="password" placeholder="please provide your password" class="input-medium" required="" type="password"> </div> </div> <!-- Password input--> <div class="control-group"> <label class="control-label" for="repeat_password">Repeat Password</label> <div class="controls"> <input id="repeat_password" name="repeat_password" placeholder="Please repeat password" class="input-medium" required="" type="password"> </div> </div> <!-- Select Basic --> <div class="control-group"> <label class="control-label" for="role">Role</label> <div class="controls"> <select id="role" name="role" class="input-medium"> <option>Nurse</option> <option>Doctor</option> <option>Other</option> </select> </div> </div> </fieldset> </form>