Question 44573 in Html Question posted in
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How Can I Make Form Under Box? – Html

Hello I want to make form under the box (new referral) how can I do it? I wanna add first name last name date of birth, phone, email, addres sections under the box but i could not solve it out. Any help appreciated. I shared my codes on code snippet. I wanna add icon and write First name side by side and I want line under first name. Others are like that too

* {
  margin: 0;
  border: 0;
  box-sizing: border-box;
  background: #CDE7ED;
}

.heading1 {
  position: absolute;
  width: 449px;
  height: 80px;
  top: 56px;
  font-family: 'Montserrat';
  font-style: normal;
  font-weight: 500;
  font-size: 30px;
  line-height: 40px;
  /* or 133% */
  text-align: center;
  background: #FFFFFF;
  color: #0B2B5B;
}

#navbar {
  position: relative;
  height: 196px;
  top: 0px;
  display: flex;
  justify-content: center;
  background: #FFFFFF;
}

.iki {
  height: 32px;
  left: 539px;
  top: 230px;
  font-family: 'Montserrat';
  font-style: normal;
  font-weight: 500;
  font-size: 24px;
  line-height: 32px;
  text-align: center;
  color: #0B2B5B;
}

.uc {
  height: 32px;
  left: 435px;
  top: 270px;
  font-family: 'Montserrat';
  font-style: normal;
  font-weight: 500;
  font-size: 20px;
  line-height: 32px;
  /* identical to box height, or 160% */
  text-align: center;
  color: #0B2B5B;
}

.box {
  position: absolute;
  width: 782px;
  height: 380px;
  left: 470px;
  top: 334px;
  background: #FFFFFF;
  box-shadow: 0px 2px 4px rgba(11, 43, 91, 0.1);
  border-radius: 4px;
}

.box-header {
  width: 782px;
  height: 64px;
  left: 249px;
  top: 334px;
  background: #FFFFFF;
  border-radius: 4px 4px 0px 0px;
  display: flex;
}

.b1 {
  width: 40px;
  height: 64px;
  left: 249px;
  top: 334px;
  background: #25A575;
  border-radius: 4px 0px 0px 0px;
}

.b11 {
  width: 10px;
  height: 32px;
  left: 264px;
  top: 350px;
  font-family: 'Montserrat';
  font-style: normal;
  font-weight: 500;
  font-size: 26px;
  line-height: 32px;
  display: flex;
  align-items: center;
  text-align: center;
  font-feature-settings: 'pnum' on, 'lnum' on;
  color: #FFFFFF;
  background: #25A575;
}

.new {
  position: sticky;
  width: 132px;
  height: 24px;
  left: 305px;
  top: 354px;
  padding-left: 10px;
  font-family: 'Montserrat';
  font-style: normal;
  font-weight: 500;
  font-size: 20px;
  line-height: 24px;
  /* identical to box height, or 120% */
  display: flex;
  align-items: center;
  font-feature-settings: 'pnum' on, 'lnum' on;
  color: #3A719B;
  background-color: white;
}

.box-body {
  width: 295px;
  height: 16px;
  left: 24px;
  top: 0px;
  font-family: 'Montserrat';
  font-style: normal;
  font-weight: 400;
  font-size: 16px;
  line-height: 16px;
  /* identical to box height, or 100% */
  display: flex;
  align-items: center;
  color: #3A719B;
}

.line {
  position: absolute;
  left: 0%;
  right: 0%;
  top: 100%;
  bottom: 0%;
  border: 1px solid #3A719B;
}
<header class="header">
    <div class="container">
        <nav id="navbar">
            <h1 class="heading1">Patient Referral Form Hayes Valley Health San Francisco </h1>

        </nav>
    </div>
</header>
<br>
<h2 class="iki">Referral Patients</h2>
<h3 class="uc">You can add up to five patients at a time</h3>
<div class="box">
    <div class="box-header">
        <div class="b1">
            <div class="b11">
                1
            </div>
        </div>
        <div class="new">
            New Referral 
        </div>
    </div>
    <br> 
</div>
Tags:

2

Answers


  1. 0

    You can rename Labels:

    * {
  margin: 0;
  border: 0;
  box-sizing: border-box;
  background: #CDE7ED;
}

.heading1 {
  position: absolute;
  width: 449px;
  height: 80px;
  top: 56px;
  font-family: 'Montserrat';
  font-style: normal;
  font-weight: 500;
  font-size: 30px;
  line-height: 40px;
  /* or 133% */
  text-align: center;
  background: #FFFFFF;
  color: #0B2B5B;
}

#navbar {
  position: relative;
  height: 196px;
  top: 0px;
  display: flex;
  justify-content: center;
  background: #FFFFFF;
}

.iki {
  height: 32px;
  left: 539px;
  top: 230px;
  font-family: 'Montserrat';
  font-style: normal;
  font-weight: 500;
  font-size: 24px;
  line-height: 32px;
  text-align: center;
  color: #0B2B5B;
}

.uc {
  height: 32px;
  left: 435px;
  top: 270px;
  font-family: 'Montserrat';
  font-style: normal;
  font-weight: 500;
  font-size: 20px;
  line-height: 32px;
  /* identical to box height, or 160% */
  text-align: center;
  color: #0B2B5B;
}

.box {
  position: absolute;
  width: 782px;
  height: 380px;
  left: 470px;
  top: 334px;
  background: #FFFFFF;
  box-shadow: 0px 2px 4px rgba(11, 43, 91, 0.1);
  border-radius: 4px;
}

.box-header {
  width: 782px;
  height: 64px;
  left: 249px;
  top: 334px;
  background: #FFFFFF;
  border-radius: 4px 4px 0px 0px;
  display: flex;
}

.b1 {
  width: 40px;
  height: 64px;
  left: 249px;
  top: 334px;
  background: #25A575;
  border-radius: 4px 0px 0px 0px;
}

.b11 {
  width: 10px;
  height: 32px;
  left: 264px;
  top: 350px;
  font-family: 'Montserrat';
  font-style: normal;
  font-weight: 500;
  font-size: 26px;
  line-height: 32px;
  display: flex;
  align-items: center;
  text-align: center;
  font-feature-settings: 'pnum' on, 'lnum' on;
  color: #FFFFFF;
  background: #25A575;
}

.new {
  position: sticky;
  width: 132px;
  height: 24px;
  left: 305px;
  top: 354px;
  padding-left: 10px;
  font-family: 'Montserrat';
  font-style: normal;
  font-weight: 500;
  font-size: 20px;
  line-height: 24px;
  /* identical to box height, or 120% */
  display: flex;
  align-items: center;
  font-feature-settings: 'pnum' on, 'lnum' on;
  color: #3A719B;
  background-color: white;
}

.box-body {
  width: 295px;
  height: 16px;
  left: 24px;
  top: 0px;
  font-family: 'Montserrat';
  font-style: normal;
  font-weight: 400;
  font-size: 16px;
  line-height: 16px;
  /* identical to box height, or 100% */
  display: flex;
  align-items: center;
  color: #3A719B;
}

.line {
  position: absolute;
  left: 0%;
  right: 0%;
  top: 100%;
  bottom: 0%;
  border: 1px solid #3A719B;
}
#frm{
  display:flex;
  flex-direction:column;
}
    <header class="header">
    <div class="container">
        <nav id="navbar">
            <h1 class="heading1">Patient Referral Form Hayes Valley Health San Francisco </h1>

        </nav>
    </div>
</header>
<br>
<h2 class="iki">Referral Patients</h2>
<h3 class="uc">You can add up to five patients at a time</h3>
<div class="box">
    <div class="box-header">
        <div class="b1">
            <div class="b11">
                1
            </div>
        </div>
        <div class="new">
            New Referral 
        </div>
      <form action="#" id="frm">
        <label for="name">Name</label>
        <input type="text" id="name">
        
        
        <label for="name2">Name</label>
        <input type="text" id="name2">
        
        
        <label for="name3">Name</label>
        <input type="text" id="name3">
        
        
        <label for="name">Name</label>
        <input type="text" id="name">
        
        
        <label for="name4">Name</label>
        <input type="text" id="name4">
        
        
        <label for="name5">Name</label>
        <input type="text" id="name5">
        <button type="submit">Send</button>
      </form>
    </div>
    <br> 
</div>

    For More Infos: https://www.w3schools.com/html/html_forms.asp

    Login or Signup to reply.
  2. 0

    Try below solution.

    *{
    margin: 0;
    border: 0;
    box-sizing: border-box;


background: #CDE7ED;
}



.heading1{
    position: absolute;
width: 449px;
height: 80px;


top: 56px;

font-family: 'Montserrat';
font-style: normal;
font-weight: 500;
font-size: 30px;
line-height: 40px;
/* or 133% */

text-align: center;

background: #FFFFFF;
color: #0B2B5B;
}

#navbar{
position: relative;
height: 196px;

top: 0px;
display: flex;
justify-content: center;

background: #FFFFFF;
}

.iki{
  
height: 32px;
left: 539px;
top: 230px;

font-family: 'Montserrat';
font-style: normal;
font-weight: 500;
font-size: 24px;
line-height: 32px;


text-align: center;

color: #0B2B5B;
}
.uc{

height: 32px;
left: 435px;
top: 270px;

font-family: 'Montserrat';
font-style: normal;
font-weight: 500;
font-size: 20px;
line-height: 32px;
/* identical to box height, or 160% */

text-align: center;

color: #0B2B5B;
}

.box{
  
    position: absolute;
    
    width: 782px;
    height: 380px;
    left: 470px;
    
    top: 334px;
    
    background: #FFFFFF;
    box-shadow: 0px 2px 4px rgba(11, 43, 91, 0.1);
    border-radius: 4px;
}

.box-header{
   
width: 782px;
height: 64px;
left: 249px;
top: 334px;

background: #FFFFFF;
border-radius: 4px 4px 0px 0px;
display: flex;
}
.b1{
    
width: 40px;
height: 64px;
left: 249px;
top: 334px;

background: #25A575;
border-radius: 4px 0px 0px 0px;

}
.b11{
   
width: 10px;
height: 32px;
left: 264px;
top: 350px;

font-family: 'Montserrat';
font-style: normal;
font-weight: 500;
font-size: 26px;
line-height: 32px;


display: flex;
align-items: center;
text-align: center;
font-feature-settings: 'pnum' on, 'lnum' on;

color: #FFFFFF;
background: #25A575;
}
.new{
  position: sticky;  
width: 132px;
height: 24px;
left: 305px;
top: 354px;
padding-left: 10px;

font-family: 'Montserrat';
font-style: normal;
font-weight: 500;
font-size: 20px;
line-height: 24px;
/* identical to box height, or 120% */

display: flex;
align-items: center;
font-feature-settings: 'pnum' on, 'lnum' on;

color: #3A719B;
background-color: white;
}

.box-body{
   
    
    width: 295px;
    height: 16px;
    left: 24px;
    top: 0px;
    
    font-family: 'Montserrat';
    font-style: normal;
    font-weight: 400;
    font-size: 16px;
    line-height: 16px;
    /* identical to box height, or 100% */
    
    display: flex;
    align-items: center;
    
    color: #3A719B;
}
.line{
    position: absolute;
left: 0%;
right: 0%;
top: 100%;
bottom: 0%;

border: 1px solid #3A719B;
}





.refField {
    width: 100%;
    margin-bottom: 1em;
    border: 1px solid blue;
    border-radius: 5px;
    height: 2em;
}

form {
    padding: 15px;
    border: 1px solid red;
}
        <!DOCTYPE html>
    <html lang="en">

    <head>
        <meta charset="UTF-8">
        <meta http-equiv="X-UA-Compatible" content="IE=edge">
        <meta name="viewport" content="width=device-width, initial-scale=1.0">
        <link rel="stylesheet" href="style.css">
        <script src="https://code.jquery.com/jquery-3.3.1.min.js"></script>
        <script src="https://cdnjs.cloudflare.com/ajax/libs/popper.js/1.14.3/umd/popper.min.js"></script>
        <link rel="stylesheet" href="https://cdnjs.cloudflare.com/ajax/libs/font-awesome/6.2.0/css/all.min.css">
        <link rel="preconnect" href="https://fonts.googleapis.com">
        <link rel="preconnect" href="https://fonts.gstatic.com" crossorigin>
        <link
            href="https://fonts.googleapis.com/css2?family=Open+Sans:wght@400;700;800&family=Oswald:wght@200;300;400&display=swap"
            rel="stylesheet">
        <link rel="stylesheet" href="https://kit.fontawesome.com/0b27183842.css" crossorigin="anonymous">
        <title>Document</title>
    </head>

    <body>
        <script src="app.js"></script>

        <header class="header">
            <div class="container">
                <nav id="navbar">
                    <h1 class="heading1">Patient Referral Form Hayes Valley Health San Francisco </h1>

                </nav>
            </div>
        </header>
        <br>
        <br>
        <br>

        <h2 class="iki">Referral Patients</h2>
        <h3 class="uc">You can add up to five patients at a time</h3>
        <div class="box">
            <div class="box-header">
                <div class="b1">
                    <div class="b11">
                        1
                    </div>
                </div>
                <div class="new">
                    New Referral
                </div>
            </div>
            <br>
            <br>
            <br>

            <form action="/action_page.php" method="get">
                <label for="name">Enter Your Name</label>
                <input type="text" name="name" id="name" class="refField">

                <label for="email">Enter Your Email</label>
                <input type="email" name="email" id="email" class="refField">

                <label for="address">Enter Your Street Address</label>
                <input type="text" name="address" id="address" class="refField">

                <label for="name">Select Your Choice</label>
                <select name="selectValue" id="Values" class="refField">
                    <option value="select">Select</option>
                    <option>Test-1</option>
                    <option>Test-2</option>
                    <option>Test-3</option>
                </select>
                <label for="zip">Zip</label>
                <input type="text" name="zip" id="zip" class="refField">

                <label for="state">State</label>
                <input type="text" name="state" id="state" class="refField">
                
            </form>

        </div>

    </body>

    </html>
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