adding elements to the checkout form

<?php  if ($FrithsCart->TotalColumn("IsContactLens") > 0) { ?>
												<li>
														<div class="checkoutOptions" id="select-practice">
																<div class="formFieldset">
																		<h2>Select Your Practice</h2>
																</div>
																<div style="clear:both; font-size: 0.9em; margin-bottom: 10px;">
																		<div>So that we can check your order against your recent eye-test, please select the Friths practice that you had your test at. <span style="font-style: italic; text-align:right;">If you didn't have your test at a Friths practice, please select 'Other Optician'.</span></div>
																</div>
																<div>
																		<select class="select sidebarPracticesDropdown" name="Practice_name" id="Practice_name" required>
																				<option value="">Select Your Practice</option>
																				<?php
while(!$PracticesDropDown->atEnd()) {
?>
																				<option value="<?php echo($PracticesDropDown->getColumnVal("PracticeName")); ?>"><?php echo($PracticesDropDown->getColumnVal("PracticeName")); ?></option>
																				<?php
  $PracticesDropDown->moveNext();
}
$PracticesDropDown->moveFirst(); //return RS to first record
?>
																				<option value="Other Optician">Other Optician</option>
																		</select>
																</div>
																<div style="clear:both; "><label><input type="checkbox" name="Eye_test_confirmation" value="Yes" id="Eye_test_confirmation" required> I have read and understand the following <a href="<?php echo $_SERVER['REQUEST_URI']; ?>#modal" style="font-size:14px;">information about eye tests</a></label></div>

														</div>
												</li>
                                              <?php } ?>