Form addition

Trying to add another few lines of code to the form

by Tyler Lazenby

HTML

<link rel="stylesheet" href="http://yui.yahooapis.com/pure/0.4.2/pure.css">
<script src="http://ajax.googleapis.com/ajax/libs/jquery/1.11.0/jquery.min.js"></script>
<script src="http://ajax.googleapis.com/ajax/libs/jqueryui/1.10.4/jquery-ui.min.js"></script>
<form action="post_2.php" method="post" class="pure-form pure-form-stacked">
			<fieldset id="DoctorInfo">
            <legend><strong>Part Two</strong> - Doctor Information</legend>
			<h2>Primary Doctor</h2>
            <div class="pure-g-r">
                <div class="pure-u-1-3">
                    <label for="doctorFirstName">Doctor First Name<span style="color: red">*</span></label>
                    <input id="doctorFirstName" name="doctorFirstName" type="text" required>
                </div>

                <div class="pure-u-1-3">
                    <label for="doctorLastName">Doctor Last Name<span style="color: red">*</span></label>
                    <input id="doctorLastName" name="doctorLastName" type="text" required>
                </div>

                <div class="pure-u-1-3">
                    <label for="establishmentName">Practice Name<span style="color: red">*</span></label>
                    <input id="establishmentName" name="establishmentName" type="text" required>
                </div>

                <div class="pure-u-1-3">
                    <label for="focusOfPractice">Type of Doctor<span style="color: red">*</span></label>
                    <input id="focusOfPractice" name="focusOfPractice" type="text" value="Primary Care Giver" readonly>
                </div>

				<div class="pure-u-1-3">
					<label for="doctorPhone">Practice Phone Number<span style="color: red">*</span></label>
					<input id="doctorPhone" name="doctorPhone" type="tel" required>
				</div>
			</div>
			
			<div id="docList"></div>
			</fieldset>
			
				
			<fieldset id="confirm2">
				<div class="pure-g-r">	
					<div class="pure-u-1">
					<style...

CSS

/*! jQuery UI - v1.10.4 - 2014-05-11
* http://jqueryui.com
* Includes: jquery.ui.core.css, jquery.ui.resizable.css, jquery.ui.selectable.css, jquery.ui.accordion.css, jquery.ui.autocomplete.css, jquery.ui.button.css, jquery.ui.datepicker.css, jquery.ui.dialog.css, jquery.ui.menu.css, jquery.ui.progressbar.css, jquery.ui.slider.css, jquery.ui.spinner.css, jquery.ui.tabs.css, jquery.ui.tooltip.css, jquery.ui.theme.css
* To view and modify this theme, visit http://jqueryui.com/themeroller/?ffDefault=Verdana%2CArial%2Csans-serif&fwDefault=normal&fsDefault=1.1em&cornerRadius=10px&bgColorHeader=%23CEB5DC&bgTextureHeader=flat&bgImgOpacityHeader=75&borderColorHeader=%23DECCD6&fcHeader=%23302636&iconColorHeader=%23e4d9ea&bgColorContent=%23DECCD6&bgTextureContent=flat&bgImgOpacityContent=75&borderColorContent=%23aaaaaa&fcContent=%23222222&iconColorContent=%23381E2D&bgColorDefault=%23D0CCDC&bgTextureDefault=highlight_hard&bgImgOpacityDefault=75&borderColorDefault=%23E1E1B7&fcDefault=%23271A2E&iconColorDefault=%23201B30&bgColorHover=%23271A2E&bgTextureHover=highlight_hard&bgImgOpacityHover=75&borderColorHover=%23E1E1B7&fcHover=%23FFFFFF&iconColorHover=%23eae9ee&bgColorActive=%23381E2D&bgTextureActive=flat&bgImgOpacityActive=65&borderColorActive=%23aaaaaa&fcActive=%23FFFFFF&iconColorActive=%23E1E1CE&bgColorHighlight=%23d064a1&bgTextureHighlight=inset_soft&bgImgOpacityHighlight=55&borderColorHighlight=%232C2838&fcHighlight=%23454526&iconColorHighlight=%232C2838&bgColorError=%23bf4f24&bgTextureError=inset_soft&bgImgOpacityError=95&borderColorError=%23cd0a0a&fcError=%23cd0a0a&iconColorError=%23cd0a0a&bgColorOverlay=%23494934&bgTextureOverlay=flat&bgImgOpacityOverlay=0&opacityOverlay=75&bgColorShadow=%232C2430&bgTextureShadow=flat&bgImgOpacityShadow=0&opacityShadow=30&thicknessShadow=8px&offsetTopShadow=-8px&offsetLeftShadow=-8px&cornerRadiusShadow=8px
* Copyright 2014 jQuery Foundation and other contributors; Licensed MIT */

/* Layout...

JavaScript

$(document).ready(function() {
	/*intial loading animation*/
	$('#vid').hide();
	$('#vid').button();
	$('#start').button();
	$('#betabutton').button();
	$('.navbar').menu();
	$('#comingSoon').hide();
	$('#serviceAlert').hide();
	$('#serviceAlert').fadeTo(2000,1).delay(3000).hide('drop', function() {
		$('#vid').show('drop', {direction: 'right'});
	});
	$('#home').tooltip();
	$('#hippa').tooltip();
	$('#alert').tooltip();
	$('#beta').tooltip();
	$('#question').tooltip();
	$('#about').tooltip();
	$('#privacy').tooltip();
	$('#accordion').accordion({collapsible: true, active: false, heightStyle: "content"});
	
	$('#vid').click(function() {
		window.open("http://youtu.be/0YPc4uoCCUk", '_newtab');
	});
	
	/*remove after services are up*/
	$('#alert').click(function() {
		$('#vid').hide();
		$('#serviceAlert').css('opacity',1).show('pulsate').delay(3000).hide('drop', function() {
			$('#vid').show('drop', {direction: 'right'});
		});
	});
	$('#hippa').click(function() {
		$('#vid').hide();
		$('#comingSoon').css('opacity',1).show('pulsate').delay(3000).hide('drop', function() {
			$('#vid').show('drop', {direction: 'right'});
		});
	});
	
	/*form functions and formatting*/
	$('$addDoc').click(function() {
		$('#docList').append('
			 <div class="pure-g-r">
                <div class="pure-u-1-3">
                    <label for="doctorFirstName">Doctor First Name<span style="color: red">*</span></label>
                    <input id="doctorFirstName" name="doctorFirstName" type="text" required>
                </div>

                <div class="pure-u-1-3">
                    <label for="doctorLastName">Doctor Last Name<span style="color: red">*</span></label>
                    <input id="doctorLastName" name="doctorLastName" type="text" required>
                </div>

                <div class="pure-u-1-3">
                    <label for="establishmentName">Practice Name<span style="color: red">*</span></label>
                    <input id="establishmentName"...