diff --git a/pwa/src/components/PatientInfoForm.tsx b/pwa/src/components/PatientInfoForm.tsx
index 305f398..980d8e8 100644
--- a/pwa/src/components/PatientInfoForm.tsx
+++ b/pwa/src/components/PatientInfoForm.tsx
@@ -9,7 +9,7 @@ import {
   WhiteSpace,
 } from "antd-mobile";
 import enUs from "antd-mobile/lib/date-picker/locale/en_US";
-import "../scss/Login.scss";
+import "../scss/PatientInfoForm.scss";
 
 const RadioItem = Radio.RadioItem;
 
@@ -45,6 +45,9 @@ export default function Form(): ReactElement {
     const nicknameField: HTMLInputElement = document.getElementById(
       "nickname"
     ) as HTMLInputElement;
+    const birthdateField: HTMLInputElement = document.getElementById(
+      "birthdate"
+    ) as HTMLInputElement;
     const complaintField1: HTMLInputElement = document.getElementById(
       "complaint1"
     ) as HTMLInputElement;
@@ -58,15 +61,17 @@ export default function Form(): ReactElement {
     console.log("First name:", firstNameField.value);
     console.log("Last name:", lastNameField.value);
     console.log("Nickname:", nicknameField.value);
+    console.log("Birth Date:", birthdateField.value);
     console.log(
       "Complaints: ",
       complaintField1.value +
-        " " +
-        complaintField2.value +
-        " " +
-        complaintField3.value
+      " " +
+      complaintField2.value +
+      " " +
+      complaintField3.value
     );
     console.log("Wants Planning?: " + planning);
+
   };
 
   return (
@@ -109,16 +114,9 @@ export default function Form(): ReactElement {
 
       <WhiteSpace />
 
-      <DatePicker
-        mode="date"
-        locale={enUs}
-        title="Birth Date"
-        extra="Birth Date"
-        data-seed="birthDate"
-      >
-        <List.Item arrow="horizontal">Birth Date</List.Item>
-        {/* TODO: figure out how to access this value */}
-      </DatePicker>
+      <InputItem placeholder="YYYY-MM-DD" id="birthdate">
+          Birth Date
+      </InputItem>
 
       <InputItem type="number" placeholder="Age" id="age">
         Age{" "}
diff --git a/pwa/src/components/PatientInfoPlaceholder.tsx b/pwa/src/components/PatientInfoPlaceholder.tsx
deleted file mode 100644
index 8dd19d3..0000000
--- a/pwa/src/components/PatientInfoPlaceholder.tsx
+++ /dev/null
@@ -1,12 +0,0 @@
-/* istanbul ignore file */
-import React, { ReactElement } from "react";
-
-export default function PatientInfoPlaceholder(): ReactElement {
-  return (
-    <img
-      src="https://i.imgur.com/K5pR07w.png"
-      alt="placeholder"
-      style={{ width: "100%", height: "100%" }}
-    ></img>
-  );
-}
diff --git a/pwa/src/scss/PatientInfoForm.scss b/pwa/src/scss/PatientInfoForm.scss
new file mode 100644
index 0000000..6451bb9
--- /dev/null
+++ b/pwa/src/scss/PatientInfoForm.scss
@@ -0,0 +1,8 @@
+#patient-info-wrapper {
+    display: flex;
+    flex-direction: column;
+
+    height: 100%;
+    width: 100%;
+  }
+  
\ No newline at end of file