Bootstrap Snippet Appointment Form using HTML Bootstrap

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<link href="//maxcdn.bootstrapcdn.com/bootstrap/3.3.0/css/bootstrap.min.css" rel="stylesheet" id="bootstrap-css">
<script src="//maxcdn.bootstrapcdn.com/bootstrap/3.3.0/js/bootstrap.min.js"></script>
<script src="//code.jquery.com/jquery-1.11.1.min.js"></script>
<!------ Include the above in your HEAD tag ---------->
<div class="container">
    <div class="row">
<div class="col-md-6">
                    <div class="well-block">
                        <div class="well-title">
                            <h2>Questions? Book an Appointment</h2>
                        </div>
                        <form>
                            <!-- Form start -->
                            <div class="row">
                                <div class="col-md-6">
                                    <div class="form-group">
                                        <label class="control-label" for="name">Name</label>
                                        <input id="name" name="name" type="text" placeholder="Name" class="form-control input-md">
                                    </div>
                                </div>
                                <!-- Text input-->
                                <div class="col-md-6">
                                    <div class="form-group">
                                        <label class="control-label" for="email">Email</label>
                                        <input id="email" name="email" type="text" placeholder="E-Mail" class="form-control input-md">
                                    </div>
                                </div>
                                <!-- Text input-->
                                <div class="col-md-6">
                                    <div class="form-group">
                                        <label class="control-label" for="date">Preferred Date</label>
                                        <input id="date" name="date" type="text" placeholder="Preferred Date" class="form-control input-md">
                                    </div>
                                </div>
                                <!-- Select Basic -->
                                <div class="col-md-6">
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"Appointment Form"
Bootstrap 3.3.0 Snippet by luispinonferrer

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"Appointment Form" Bootstrap 3.3.0 Snippet by luispinonferrer

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Questions / Comments:

"Appointment Form"
Bootstrap 3.3.0 Snippet by luispinonferrer