<div class="row">
   <div class="col-md-6">
      <div class="form-group">
          [text* YourName id:name class:form-control placeholder "Your Name"]
      </div>
   </div>
   <div class="col-md-6">
      <div class="form-group">
        [email* Email id:email class:form-control placeholder "Your Email"]
      </div>
   </div>
   <div class="col-md-6">
      <div class="form-group">
        [tel* Phone id:phone class:form-control placeholder "Phone"]
      </div>
   </div>
   <div class="col-md-6">
      <div class="form-group">
        [select* Services id:name class:form-control "Services" "Neurology" "Urology"]
      </div>
   </div>
</div>

<div class="form-group">
    [textarea* Message id:message class:form-control placeholder "Message"]       
</div>

[submit id:submit class:submit-btn class:hdk-btn "Get In Touch"]