<div class="bt_bb_cf7_form bt_bb_cf7_inline_bottom_form">
<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 class="bt_bb_cf7_element bt_bb_cf7_button bt_bb_accent_submit">[submit "Book"]</div>
</div>
</div>