<table>

<tr>

<td> <input type="text" placeholder="First

Name">
<td> <input type="text" placeholder="Last
Name">
</tr>
<tr height="30px">

</tr>
<tr>

<td> <input type="text" placeholder="Email

Id">
<td> <input type="text" placeholder="Mobile
No">
</tr>

<tr height="30px">

</tr>
<tr>

<td> <select> <option> -- Sex -- </option>

<option> Male </option> <option> Female </option> </select>
<td> <input type="text"
placeholder="appointment date">
</tr>

<tr height="30px">

</tr>
<tr>

<td colspan="1"> <textarea

placeholder="Message"> </textarea>
</tr>

<tr height="30px">

</tr>
<tr>
<td width="500px"> </td>
<td colspan="1"> <button> SUBMIT </button>
</tr>
</table>