JSFiddle - React, Tailwind, and code Playground

HTML

<form id="form1" name="form1" method="post" style="transition: 3s height; overflow: hidden;">
    <table width="100%" border="0" cellspacing="2" cellpadding="5">
        <tbody>
            <tr>
                <td width="25%" align="right">Practitioner's Full Name<span style="color:red;">*</span>
                </td>
                <td style="text-align: left">
                    <input name="name" type="text" required="" pattern=".{3,}">
                </td>
            </tr>
            <tr>
                <td width="25%" align="right">Type<span style="color:red;">*</span>
                </td>
                <td style="text-align: left">
                    <select name="type" required="">
                        <option value="MD">MD</option>
                        <option value="OD">OD</option>
                        <option value="OTHER">OTHER</option>
                    </select>
                </td>
            </tr>
            <tr>
                <td align="right">Street Address<span style="color:red;">*</span>
                </td>
                <td style="text-align: left">
                    <input name="address" type="text" required="" pattern=".{3,}">
                </td>
            </tr>
            <tr>
                <td align="right">City<span style="color:red;">*</span>
                </td>
                <td style="text-align: left">
                    <input name="city" type="text" required="" pattern=".{3,}">
                </td>
            </tr>
            <tr>
                <td align="right">State<span style="color:red;">*</span>
                </td>
                <td style="text-align: left">
                    <select name="state" id="state" required="">
                        <option value="AL" selected="">Alabama</option>
                        <option value="AK">STATES</option>
                    </select>
                </td>
            </tr>
            <tr>
                <td...

JavaScript

jQuery(function($) {
            $(".datepicker").datepicker({
                numberOfMonths: 3,
                showButtonPanel: true
            });
            $("#form1").submit(function() {
                var url = "example.com/process.php"; // the script where you handle the form input.
                $.post(url, {
                    name: $("input[name='name']").val(),
                    type: $("select[name='type'] option:selected").text(),
                    address: $("input[name='address']").val(),
                    city: $("input[name='city']").val(),
                    state: $("select[name='state'] option:selected").text(),
                    zip: $("input[name='zip']").val(),
                    phone: $("input[name='phone']").val(),
                    email: $("input[name='email']").val(),
                    sig: $("input[name='sig']").val(),
                    date: $(".date1").datepicker("getDate"),
                    lic_numb: $("input[name='lic_numb']").val(),
                    lic_date: $(".date2").datepicker("getDate"),
                    code: 'tEH4s'
                }).done(function(data) {
                    $(".result").html(data);
                    $('input').val('');
                    $('#form1').css("height", "0");
                });
                return false; // avoid to execute the actual submit of the form.
            });
        });