diff --git a/src/components/SurveyForm/Inputs.js b/src/components/SurveyForm/Inputs.js
new file mode 100644
index 000000000..c6221e7b8
--- /dev/null
+++ b/src/components/SurveyForm/Inputs.js
@@ -0,0 +1,51 @@
+import React from 'react';
+
+const styles = require('./SurveyForm.scss');
+
+const flags = (field) =>
+  <div className={styles.flags}>
+    {field.dirty && <span className={styles.dirty} title="Dirty">D</span>}
+    {field.active && <span className={styles.active} title="Active">A</span>}
+    {field.visited && <span className={styles.visited} title="Visited">V</span>}
+    {field.touched && <span className={styles.touched} title="Touched">T</span>}
+  </div>;
+
+
+export const input = (field, label, asyncValidating, showAsyncValidating) =>
+  <div className={'form-group' + (field.error && field.touched ? ' has-error' : '')}>
+    <label htmlFor={field.name} className="col-sm-2">{label}</label>
+    <div className={'col-sm-8 ' + styles.inputGroup}>
+      {showAsyncValidating && asyncValidating && <i className={'fa fa-cog fa-spin ' + styles.cog}/>}
+      <input type="text" className="form-control" id={field.name} {...field}/>
+      {field.error && field.touched && <div className="text-danger">{field.error}</div>}
+      {flags(field)}
+    </div>
+  </div>;
+
+export const textArea = (field, label, asyncValidating, showAsyncValidating) =>
+  <div className={'form-group' + (field.error && field.touched ? ' has-error' : '')}>
+    <label htmlFor={field.name} className="col-sm-2">{label}</label>
+    <div className={'col-sm-8 ' + styles.inputGroup}>
+      {showAsyncValidating && asyncValidating && <i className={'fa fa-cog fa-spin ' + styles.cog}/>}
+      <textarea type="text" className="form-control" id={field.name} {...field}/>
+      {field.error && field.touched && <div className="text-danger">{field.error}</div>}
+      {flags(field)}
+    </div>
+  </div>;
+
+export const selector = (inputs, field, label, asyncValidating, showAsyncValidating) =>
+  <div className={'form-group' + (field.error && field.touched ? ' has-error' : '')}>
+    <label htmlFor={field.name} className="col-sm-2">{label}</label>
+    <div className={'col-sm-8 ' + styles.inputGroup}>
+      {showAsyncValidating && asyncValidating && <i className={'fa fa-cog fa-spin ' + styles.cog}/>}
+      <select className="form-control" id={field.name} {...field}>
+         {
+           inputs.map((data) => {
+             return <option key={data.show} value={data.value}>{data.show}</option>;
+           })
+         }
+      </select>
+      {field.error && field.touched && <div className="text-danger">{field.error}</div>}
+      {flags(field)}
+    </div>
+  </div>;
diff --git a/src/components/SurveyForm/SurveyForm.js b/src/components/SurveyForm/SurveyForm.js
index 7c764233d..a4ea6ed24 100644
--- a/src/components/SurveyForm/SurveyForm.js
+++ b/src/components/SurveyForm/SurveyForm.js
@@ -4,6 +4,7 @@ import {connect} from 'react-redux';
 import {bindActionCreators} from 'redux';
 import surveyValidation from './surveyValidation';
 import * as surveyActions from 'redux/modules/survey';
+import {input, textArea, selector} from './Inputs';
 
 function asyncValidate(data, dispatch, {isValidEmail}) {
   if (!data.email) {
@@ -16,7 +17,8 @@ function asyncValidate(data, dispatch, {isValidEmail}) {
 )
 @reduxForm({
   form: 'survey',
-  fields: ['name', 'email', 'occupation', 'currentlyEmployed', 'sex'],
+  fields: ['name', 'email', 'occupation',
+   'currentlyEmployed', 'sex', 'address', 'blood'],
   validate: surveyValidation,
   asyncValidate,
   asyncBlurFields: ['email']
@@ -39,7 +41,8 @@ class SurveyForm extends Component {
     const {
       asyncValidating,
       dirty,
-      fields: {name, email, occupation, currentlyEmployed, sex},
+      fields: {name, email, occupation,
+        currentlyEmployed, sex, address, blood},
       active,
       handleSubmit,
       invalid,
@@ -48,28 +51,23 @@ class SurveyForm extends Component {
       valid
       } = this.props;
     const styles = require('./SurveyForm.scss');
-    const renderInput = (field, label, showAsyncValidating) =>
-      <div className={'form-group' + (field.error && field.touched ? ' has-error' : '')}>
-        <label htmlFor={field.name} className="col-sm-2">{label}</label>
-        <div className={'col-sm-8 ' + styles.inputGroup}>
-          {showAsyncValidating && asyncValidating && <i className={'fa fa-cog fa-spin ' + styles.cog}/>}
-          <input type="text" className="form-control" id={field.name} {...field}/>
-          {field.error && field.touched && <div className="text-danger">{field.error}</div>}
-          <div className={styles.flags}>
-            {field.dirty && <span className={styles.dirty} title="Dirty">D</span>}
-            {field.active && <span className={styles.active} title="Active">A</span>}
-            {field.visited && <span className={styles.visited} title="Visited">V</span>}
-            {field.touched && <span className={styles.touched} title="Touched">T</span>}
-          </div>
-        </div>
-      </div>;
+
+    const bloodData = [
+      {value: '', show: 'please select'},
+      {value: 'A', show: 'A'},
+      {value: 'B', show: 'B'},
+      {value: 'O', show: 'O'},
+      {value: 'AB', show: 'AB'},
+    ];
 
     return (
       <div>
         <form className="form-horizontal" onSubmit={handleSubmit}>
-          {renderInput(name, 'Full Name')}
-          {renderInput(email, 'Email', true)}
-          {renderInput(occupation, 'Occupation')}
+          {input(name, 'Full Name', asyncValidating)}
+          {input(email, 'Email', asyncValidating, true)}
+          {input(occupation, 'Occupation', asyncValidating)}
+          {textArea(address, 'Address', asyncValidating)}
+          {selector(bloodData, blood, 'Blood group', asyncValidate)}
           <div className="form-group">
             <label htmlFor="currentlyEmployed" className="col-sm-2">Currently Employed?</label>
             <div className="col-sm-8">
diff --git a/src/components/SurveyForm/surveyValidation.js b/src/components/SurveyForm/surveyValidation.js
index 93a63a6ac..92081c1fd 100644
--- a/src/components/SurveyForm/surveyValidation.js
+++ b/src/components/SurveyForm/surveyValidation.js
@@ -4,6 +4,8 @@ import {createValidator, required, maxLength, email} from 'utils/validation';
 const surveyValidation = createValidator({
   name: [required, maxLength(10)],
   email: [required, email],
-  occupation: maxLength(20) // single rules don't have to be in an array
+  occupation: maxLength(20), // single rules don't have to be in an array
+  address: maxLength(100),
+  blood: [required, maxLength(2)]
 });
 export default memoize(10)(surveyValidation);
diff --git a/src/containers/Survey/Survey.js b/src/containers/Survey/Survey.js
index 0473f8758..926ad63f9 100644
--- a/src/containers/Survey/Survey.js
+++ b/src/containers/Survey/Survey.js
@@ -23,7 +23,9 @@ export default class Survey extends Component {
       email: 'bobby@gmail.com',
       occupation: 'Redux Wizard',
       currentlyEmployed: true,
-      sex: 'male'
+      sex: 'male',
+      address: '99/999 thailand',
+      blood: 'A'
     });
   }