<div class="main-wrapper">
  <div class="form-wrapper">
    <form
  action="https://formbold.com/s/YOUR_KEY"
  method="POST">
      <div class="mb-5">
        <label for="name" class="form-label"> Full Name </label>
        <input
          type="text"
          name="name"
          id="name"
          placeholder="Full Name"
          class="form-input"
        />
      </div>
      <div class="mb-5">
        <label for="phone" class="form-label"> Phone Number </label>
        <input
          type="text"
          name="phone"
          id="phone"
          placeholder="Enter your phone number"
          class="form-input"
        />
      </div>
      <div class="mb-5">
        <label for="email" class="form-label"> Email Address </label>
        <input
          type="email"
          name="email"
          id="email"
          placeholder="Enter your email"
          class="form-input"
        />
      </div>
      <div class="flex flex-wrap -mx-3">
        <div class="w-full sm:w-half px-3">
          <div class="mb-5 w-full">
            <label for="date" class="form-label"> Date </label>
            <input type="date" name="date" id="date" class="form-input" />
          </div>
        </div>
        <div class="w-full sm:w-half px-3">
          <div class="mb-5">
            <label for="time" class="form-label"> Time </label>
            <input type="time" name="time" id="time" class="form-input" />
          </div>
        </div>
      </div>

      <div class="mb-5 pt-3">
        <label class="form-label form-label-2"> Address Details </label>
        <div class="flex flex-wrap -mx-3">
          <div class="w-full sm:w-half px-3">
            <div class="mb-5">
              <input
                type="text"
                name="area"
                id="area"
                placeholder="Enter area"
                class="form-input"
              />
            </div>
          </div>
          <div class="w-full sm:w-half px-3">
            <div class="mb-5">
              <input
                type="text"
                name="city"
                id="city"
                placeholder="Enter city"
                class="form-input"
              />
            </div>
          </div>
          <div class="w-full sm:w-half px-3">
            <div class="mb-5">
              <input
                type="text"
                name="state"
                id="state"
                placeholder="Enter state"
                class="form-input"
              />
            </div>
          </div>
          <div class="w-full sm:w-half px-3">
            <div class="mb-5">
              <input
                type="text"
                name="post-code"
                id="post-code"
                placeholder="Post Code"
                class="form-input"
              />
            </div>
          </div>
        </div>
      </div>

      <div>
        <button class="btn">Book Appointment</button>
      </div>
    </form>
  </div>
</div>
<style>
  * {
    margin: 0;
    padding: 0;
    box-sizing: border-box;
  }
  body {
    font-family: "Inter";
  }
  .mb-5 {
    margin-bottom: 20px;
  }
  .pt-3 {
    padding-top: 12px;
  }
  .main-wrapper {
    display: flex;
    align-items: center;
    justify-content: center;
    padding: 48px;
  }

  .form-wrapper {
    margin: 0 auto;
    max-width: 550px;
    width: 100%;
    background: white;
  }
  .form-label {
    display: block;
    font-weight: 500;
    font-size: 16px;
    color: #07074d;
    margin-bottom: 12px;
  }
  .form-label-2 {
    font-weight: 600;
    font-size: 20px;
    margin-bottom: 20px;
  }

  .form-input {
    width: 100%;
    padding: 12px 24px;
    border-radius: 6px;
    border: 1px solid #e0e0e0;
    background: white;
    font-weight: 500;
    font-size: 16px;
    color: #6b7280;
    outline: none;
    resize: none;
  }
  .form-input:focus {
    border-color: #6a64f1;
    box-shadow: 0px 3px 8px rgba(0, 0, 0, 0.05);
  }

  .btn {
    text-align: center;
    font-size: 16px;
    border-radius: 6px;
    padding: 14px 32px;
    border: none;
    font-weight: 600;
    background-color: #6a64f1;
    color: white;
    width: 100%;
    cursor: pointer;
  }
  .btn:hover {
    box-shadow: 0px 3px 8px rgba(0, 0, 0, 0.05);
  }

  .-mx-3 {
    margin-left: -12px;
    margin-right: -12px;
  }
  .px-3 {
    padding-left: 12px;
    padding-right: 12px;
  }
  .flex {
    display: flex;
  }
  .flex-wrap {
    flex-wrap: wrap;
  }
  .w-full {
    width: 100%;
  }
  @media (min-width: 540px) {
    .sm\:w-half {
      width: 50%;
    }
  }
</style>