<div class="contact-one__form contact-form-validated"> <div class="row"> <div class="col-md-6"> [text name placeholder "Full Name"] </div><div class="col-md-6"> [text email placeholder "Email Address"] </div><div class="col-md-6"> [text phone placeholder "Phone Number"] </div><div class="col-md-6"> [select discussion class:selectpicker "Discussion For" "Basic Query" "Patient Admission"] </div><div class="col-md-12"> [textarea message placeholder "Message"] </div><div class="col-md-12 text-left"> [submit class:thm-btn class:contact-one__btn "Submit Now"] </div></div></div>