<div class="contact7__custom-form"> <div class="input-group"> [text* your-name class:form-control placeholder "Your Name"] </div> <div class="row row-sm-space mt-1"> <div class="col"> <div class="input-group"> [email* your-email class:form-control placeholder "Your Email"] </div> </div> <div class="col"> <div class="input-group"> [text requestphone class:form-control placeholder "Your Phone"] </div> </div> </div> <div class="selectWrapper input-group mt-1"> [select requestservice class:form-control "Cosmetic Dentistry" "General Dentistry" "Orthodontics" "Children`s Dentistry" "Dental Implants" "Dental Emergency"] </div> <div class="row row-sm-space mt-1"> <div class="col"> <div class="input-group7 flex-nowrap"> <div class="datepicker-wrap7"> [date requestdate class:form-control class:datetimepicker] </div> </div> </div> </div> <div class="text-right mt-2">[submit class:btn class:btn-sm class:btn-hover-fill "Request"]</div></div>