test

Full Name:
[text* fullname id:fullname placeholder "Enter your full name" required]

Email:
[email* email id:email placeholder "Enter your email address" required]

Phone Number:
[tel* phone id:phone placeholder "Enter your phone number" required]

Preferred Date:
[date* preferred_date id:preferred_date placeholder "Select your preferred date" required]

Preferred Time:
—Please choose an option—Select your preferred timeMorning (9:00 AM - 12:00 PM)Afternoon (12:00 PM - 3:00 PM)Evening (3:00 PM - 6:00 PM)No preference

Message (Optional):

Note: Appointment confirmation will be sent to your email.