<div class="overflow-hidden">
<div class="half-column half-column-left">
    [text* your-name placeholder "Name"][email* your-email placeholder "Email address"][date date placeholder "Appointment Date"]
</div>
<div class="half-column half-column-right">
    [textarea your-message placeholder "Message"]
</div>
</div>
<p>[submit "Make an Appointment"]</p>