Using Bootstrap, create the following:

1. A webpage that requests a patient in a doctors office to enter typical information that a new patient must provide. Personal information (such as name, address, and ?), other doctor information (such as a specialist), medical information (such as history of illnesses and surgeries) and medicines (such as over-the-counter and perscriptions).

2. The Form must include textboxes, dropdown lists, radio buttons and check boxes to accept the information.

3. Submit the form (in the form tag line) to: http://www.littleoceanwaves.com/returnvalues.php

4. The form must include at least two alerts as shown in this module.

Test your form. Make sure it submits all the data to the web page (#3). The returnvalues webpage should show you what you ALL of what was submitted.

5. Test to make sure the form properly resizes at full size and smart phone size.