<form action="http://esorthodontics.createsend.com/t/d/s/njyuyy/" method="post" id="subForm">
    <p>
        <label for="fieldName">Name</label><br />
        <input id="fieldName" name="cm-name" type="text" />
    </p>
    <p>
        <label for="fieldEmail">Email</label><br />
        <input id="fieldEmail" name="cm-njyuyy-njyuyy" type="email" required />
    </p>
    <p>
        <label for="fieldkkuyly">Phone Number</label><br />
        <input id="fieldkkuyly" name="cm-f-kkuyly" type="text" />
    </p>
    <p>
        <button type="submit">Subscribe</button>
    </p>
</form>