Hello there! I am trying to create a form underneath the box labeled "New Referral," but I'm having trouble figuring it out. I would like to include sections for first name, last name, date of birth, phone number, email, and address under the box. Any assistance would be greatly appreciated. I have shared my code snippet below. My goal is to display an icon next to the "First Name" text and have a line right under it, with similar styling for the other input fields as well.
* {
margin: 0;
border: 0;
box-sizing: border-box;
background: #CDE7ED;
}
... (additional CSS code here)
<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>