<link href="//netdna.bootstrapcdn.com/bootstrap/3.0.0/css/bootstrap.min.css" rel="stylesheet" id="bootstrap-css"> <script src="//netdna.bootstrapcdn.com/bootstrap/3.0.0/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>Patient Creation </legend> <!-- File Button --> <div class="form-group"> <label class="col-md-4 control-label" for="Photo">Photo</label> <div class="col-md-4"> <input id="Photo" name="Photo" class="input-file" type="file"> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="Registration Number ">Registration Number </label> <div class="col-md-4"> <input id="Registration Number " name="Registration Number " type="text" placeholder="" class="form-control input-md"> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="BHT Number">BHT Number</label> <div class="col-md-4"> <input id="BHT Number" name="BHT Number" type="text" placeholder="" class="form-control input-md"> </div> </div> <!-- Select Basic --> <div class="form-group"> <label class="col-md-4 control-label" for="selectbasic">Marriage Status</label> <div class="col-md-4"> <select id="selectbasic" name="selectbasic" class="form-control"> <option value="1">Married</option> <option value="2">Unmarried</option> </select> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="Patient Name ">Patient Name </label> <div class="col-md-4"> <input id="Patient Name " name="Patient Name " type="text" placeholder="" class="form-control input-md"> </div> </div> <!-- Select Basic --> <div class="form-group"> <label class="col-md-4 control-label" for="Patient Status ">Patient Status </label> <div class="col-md-4"> <select id="Patient Status " name="Patient Status " class="form-control"> <option value="1">Option one</option> <option value="2">Option two</option> <option value="3">Option three</option> </select> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="textinput">Registration Date </label> <div class="col-md-4"> <input id="textinput" name="textinput" type="text" placeholder="Registration Date " class="form-control input-md"> </div> </div> <!-- Multiple Radios --> <div class="form-group"> <label class="col-md-4 control-label" for="Gender">Gender</label> <div class="col-md-4"> <div class="radio"> <label for="Gender-0"> <input type="radio" name="Gender" id="Gender-0" value="1" checked="checked"> Option one </label> </div> <div class="radio"> <label for="Gender-1"> <input type="radio" name="Gender" id="Gender-1" value="2"> Option two </label> </div> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="Date of Birth">Date of Birth</label> <div class="col-md-4"> <input id="Date of Birth" name="Date of Birth" type="text" placeholder="" class="form-control input-md"> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="NIC">NIC</label> <div class="col-md-4"> <input id="NIC" name="NIC" type="text" placeholder="" class="form-control input-md"> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="Relation">Relation</label> <div class="col-md-4"> <input id="Relation" name="Relation" type="text" placeholder="" class="form-control input-md"> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="Guardian">Guardian</label> <div class="col-md-4"> <input id="Guardian" name="Guardian" type="text" placeholder="" class="form-control input-md"> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="Contact Number">Contact Number</label> <div class="col-md-4"> <input id="Contact Number" name="Contact Number" type="text" placeholder="" class="form-control input-md"> </div> </div> <!-- Textarea --> <div class="form-group"> <label class="col-md-4 control-label" for="Address">Address</label> <div class="col-md-4"> <textarea class="form-control" id="Address" name="Address"></textarea> </div> </div> <!-- Button --> <div class="form-group"> <label class="col-md-4 control-label" for="Save"></label> <div class="col-md-4"> <button id="Save" name="Save" class="btn btn-success">Save</button> </div> </div> </fieldset> </form>