<div class="appointment-form-1 main-form"> <div class="row"> <div class="col-md-6"> <div class="input-group">[text your-email placeholder "Your email address *"]</div></div><div class="col-md-6"> <div class="input-group"> [text appointment-date placeholder "Appointment date *"] </div></div></div><div class="row"> <div class="col-md-6"> <div class="input-group">[select SelectYourDoctor "Select Your Doctor" "Dr. Anna Willey" "Dr. Edward Berry" "Dr. Eliza William" "Dr. Charlie Smith" "Dr. Maria Mitchell"]</div></div><div class="col-md-6"> <div class="input-group">[submit "Book Your Doctor"]</div></div></div></div>