Input fields are not passed to the Text Field when viewed on an embedded form

My form is displaying well on the FORM PREVIEW.

I have inserted the same form on my website using the shortcode, but it's not working well. See attached screen short for more details.

Here's the link of my website with the form: http://www.myeasydrop.com/book-now/

I checked both your website and the standalone version of your Form, but failed to see any difference.

Here's how they looked like from my perspective:

We can only assume you either figured it out or managed to fix it after posting your question but just in case you need more help, don't hesitate to let us know so we can have another look.