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</br>
</br>
<label>Your Name (*)</label> [text* YourName placeholder akismet:author “Enter your name”]

<label>Your Hotel (*)</label> [text* YourHotel placeholder “Enter your hotel”]

<label>Room Number(*)</label>[number* RoomNumber placeholder “Enter number”] [checkbox* Gender label_first “Male” “Female”]

<label>Your Email(*)</label> [email* Email placeholder akismet:author_email “Enter your email”]

<label>Estimated time(*)</label> [select* menu include_blank “One hour” “One and a half hour” “Two hours” “Two and a half hours” “Three hours” “Three and a half hours” “Four hours” “Four and a half hours”]

<label>Date of Treatment (*)</label> [date* date placeholder “Choose date”]

<label>Preferred Time (*)</label> [select menu include_blank “09:30 AM” “10 AM” “10:30 AM” “11 AM” “11:30 AM” “12 PM” “12:30 PM” “01 PM” “01:30 PM” “02 PM” “02:30 PM” “03 PM” “03:30 PM” “04 PM” “04:30 PM” “05 PM” “05:30 PM” “06 PM” “06:30 PM” “07 PM” “07:30 PM” “08 PM” “08:30 PM” “09 PM”]

<label>Special Request</label> [textarea SpecialRequest placeholder “Enter special request you want”] [submit class:button primary “Submit”]