<div class="row">
	<div class="input-filled col-lg-6 col-md-6"><label><i class="fac fac-user"></i>First name *</label>[text* your-name placeholder "Jhon"]</div>
	<div class="input-filled col-lg-6 col-md-6"><label><i class="fac fac-user"></i>Last name *</label>[text* your-name placeholder "Doe"]</div>
</div>
<div class="row">
	<div class="input-filled col-lg-6 col-md-6"><label><i class="fac fac-envelope"></i>Your mail *</label>[email* your-email placeholder "info@gmail.com"]</div>
	<div class="input-filled col-lg-6 col-md-6"><label><i class="fac fac-phone-alt"></i>Phone number *</label>[text* your-phone placeholder "Your number"]</div>
</div>
<div class="row">
	<div class="input-filled col-12"><label><i class="fac fac-pen"></i>Message...</label>[textarea* your-message placeholder "Type your message..."]</div>
	<div class="input-filled col-12"><button type="submit" class="wpcf7-submit btn btn-block"><i class="fac fac-arrow-circle-right space-right"></i>Make an appionment</button></div>
</div>