[section_break section_break-832 "Online Booking Form"]


    
        <label> First Name *
            [text* first-name placeholder "Alex"] </label>
    
    
        <label> Last Name *
            [text* last-name placeholder "Piter"] </label>
    



    
        <label> Phone Number *
            [phone* phone-248] </label>
    
    
        <label> Email Address *
            [email* email-35 placeholder "[email protected]"] </label>
    



    
        <label> Desired Booking Date *
            [booking_date* booking_date-355] </label>
    
    
        <label> Desired Booking Time *
            [booking_time* booking_time-535] </label>
    


<label> Are you a *
    [select* select-692 first_as_label "Select" "New Customer" "Existing Customer"] </label>

<label> Which procedure do you want to have? *
    [textarea procedure x3] </label> 

<label> Additional Message
    [textarea additional-msg x3] </label> 
    
[submit "Submit"]