<div class="bt_bb_cf7_form bt_bb_cf7_twocol_form">
<div class="bt_bb_cf7_row">
<div class="bt_bb_cf7_element"><p><span class="bt_bb_required">Your name</span></p>[text* your-name]</div>
<div class="bt_bb_cf7_element"><p><span class="bt_bb_required">Your Email Address</span></p>[email* your-email] </div>
</div>
<div class="bt_bb_cf7_row">
<div class="bt_bb_cf7_element"><p>Choose your Dentist</p>[select Doctor first_as_label "Select Dentist here" "Allen Fischer" "Alex Terrel" "Michél Anderson" "Edwin Southgate" "Carlie Addison" ]</div>
<div class="bt_bb_cf7_element"><p><span class="bt_bb_required">Appointment date</span></p>[date* date-638 placeholder "Appointment date"]</div>
</div>
<div class="bt_bb_cf7_button bt_bb_cf7_button_larger bt_bb_alternate_submit bt_bb_align_to_center">[submit "Book Appointment Now"]</div>
</div>