{!! Form::text('name', null,['id' => 'newsletter-name', 'class'=>'form-control', 'required' => 'required', 'placeholder'=>'Your name ...']) !!}

{!! Form::text('email', null, ['id' => 'newsletter-email', 'type' => 'email', 'required' => 'required', 'class' => 'form-control', 'placeholder' => 'Your email address ...']) !!}

{!! Form::text('phone', null,['id' => 'newsletter-phone', 'class'=>'form-control', 'required' => 'required', 'placeholder'=>'Your phone number ...']) !!}

{!! Form::select('speciality', ['General Dentist' => 'General Dentist', 'Pediatric Dentistry' => 'Pediatric Dentistry', 'Oral Surgeon' => 'Oral Surgeon', 'Implant Dentistry' => 'Implant Dentistry', 'Cosmetic Dentistry' => 'Cosmetic Dentistry', 'Reconstructive Dentistry' => 'Reconstructive Dentistry', 'Orthodonitis' => 'Orthodonitis', 'Endodontics' => 'Endodontics', 'Hynenics' => 'Hynenics'] ,null ,['id' => 'newsletter-speciality', 'class'=>'form-control', 'required' => 'required', 'placeholder' => 'Your speciality ...']) !!}

{!! Form::select('role', ['Dentist' => 'Dentist', 'Technician' => 'Technician', 'Office Manager' => 'Office Manager', 'Clinic Owner' => 'Clinic Owner', 'Associated with Hospital' => 'Associated with Hospital', 'Other' => 'Other'] ,null ,['id' => 'newsletter-role', 'class'=>'form-control', 'required' => 'required', 'placeholder'=>'Your role ...']) !!}

{!! Form::text('company', null,['id' => 'newsletter-company', 'class'=>'form-control', 'placeholder'=>'Your institute / company ...']) !!}