https://medcentricpharmacy.com/login/modal

1<!--=== Content Part ===-->   
2<div class="panel panel-default">
3    <div class="panel-body">
4    <div class="service-block service-block-default clearfix" style="margin-bottom:-10px;">
5        <div class="clearfix"><button type="button" class="close" data-dismiss="modal" aria-label="Close"><span aria-hidden="true">&times;</span></button></div>
6        <div class="heading-title heading-dotted text-center">
7            <h2>Sign In</h2>
8            <p>Don't Have an Account? <a class="color-green" href="/register">Click here to sign up!</a></p>
9        </div>
10                        <form method="post" action="/login/auth/" autocomplete="off" class="sky-form" id="login-form">
11            <div class="input-group">
12                <span class="input-group-addon"><i class="fa fa-user"></i></span>
13                <input type="text" class="form-control" id="username" name="username" aria-label="Username" placeholder="Username">
14            </div>
15            <div class="margin-bottom-20"></div>
16            <div class="input-group">
17                <span class="input-group-addon"><i class="fa fa-lock"></i></span>
18                <input type="password" class="form-control" id="password" name="password" aria-label="Password" placeholder="Password">
19            </div>
20            <div class="margin-bottom-20"></div>
21            <div class="text-center">
22                <a href="/password">Forgot username/password?</a>
23            </div>
24            <hr>                    
25            <div class="row">
26                <div class="col-xs-12">
27                    <button type="submit" class="btn btn-primary btn-3d btn-block" aria-label="Login">Login</button>
28                </div>
29            </div>
30            <div class="clearfix"></div>
31        </form>
32    </div>
33    </div>
34</div>
35    <!--End Reg Block-->
36
37
38<!-- JS Implementing Plugins -->           

39<script type="text/javascript" src="https://cdn.refillrxconnect.com/themes/4/assets/plugins/sky-forms-pro/skyforms/js/jquery.validate.min.js"></script>

39
40

41<script type="text/javascript">
42    jQuery(document).ready(function() {
43        Validation.initValidation();     
44    });
45</script>