[select* menu-919 “Department” “Pathology” “X-Ray” “Gynecology”] [text* fullname placeholder “Full Name”] [email* email placeholder “Email”] [date* appointmentdate placeholder “Appointment Date”] [textarea message x4 placeholder “Message”] [submit “Submit”] 1 [your-subject] [your-name] wordpress@plethorathemes.com From: [your-name] Subject: [your-subject] Message Body: [your-message] — This e-mail was sent from a contact form on HealthFlex (http://plethorathemes.com/healthflex) Reply-To: wordpress@plethorathemes.com [your-subject] HealthFleX [your-email] […]