<p>Client / Parents Name (required)<br />
[text* your-name] </p>

<p> Due Date (required)<br />
[textarea* duedate x4] </p>

<p>Your phone number (required)<br />
[text phone]</p>

<p>Your Email (required)<br />
[email* your-email] </p>

<p> Have you already booked a maternity (required)<br />
[Have you already booked a maternity session Y/n?] </p

<p>[submit “Send”]</p>