.form_text_input {
  border-width: 0 0 1px 0;
  border-color: #000;
  border-bottom: 1px solid #000;
  margin: 0 10px;
  padding: 10px;
  width:35%;
}
#date1 {
    width: 45%;
}
#to1 {
    width: 85%;
}
#Doctor{
    text-align: center;
    margin-top: -1px;
}
#address1 {
    width: 81%;
}
#claire{
    text-align: center;
}   
#name{
    width:55%;
}
#birth{
    width:15%;
}
#Signature{
    width:75%;
}