<div class="bt_bb_cf7_form">
    <div class="bt_bb_cf7_row">
        <div class="bt_bb_cf7_element">[text* your-name placeholder "Enter your Name *"]</div></div>
    <div class="bt_bb_cf7_row">
        <div class="bt_bb_cf7_element">[email* your-email placeholder "Enter your Email Address *"]</div></div>
    <div class="bt_bb_cf7_row">
        <div class="bt_bb_cf7_element">[select menu-974 "Please select your dentist" "Allen Fischer" "Alex Terrel" "Michél Anderson" "Edwin Southgate" "Carlie Addison"]</div></div>
    <div class="bt_bb_cf7_row">
        <div class="bt_bb_cf7_element">[date* appointment-date placeholder "Appointment date *"]</div></div>
    <div class="bt_bb_cf7_row">
        <div class="bt_bb_cf7_element">[textarea your-message x9 placeholder "Additional Message"]</div></div>
    <div class="bt_bb_cf7_row">
        <div class="bt_bb_cf7_button bt_bb_cf7_button_larger bt_bb_cf7_element">[submit "Book Appointment"]</div></div>
</div>