<link href="//maxcdn.bootstrapcdn.com/bootstrap/4.1.1/css/bootstrap.min.css" rel="stylesheet" id="bootstrap-css">
<script src="//maxcdn.bootstrapcdn.com/bootstrap/4.1.1/js/bootstrap.min.js"></script>
<script src="//cdnjs.cloudflare.com/ajax/libs/jquery/3.2.1/jquery.min.js"></script>
<link rel="stylesheet" href="https://maxcdn.bootstrapcdn.com/font-awesome/4.2.0/css/font-awesome.min.css">
<div class="container mt-5">
<div class="row justify-content-center">
<div class="col-md-6">
<form id="captcha-form" method="post" action="" class="mb-3">
<div class="mb-3">
<label for="name" class="form-label">Name</label>
<input type="text" class="form-control" id="name" name="name" required>
</div>
<div class="mb-3">
<label for="email" class="form-label">Email</label>
<input type="email" class="form-control" id="email" name="email" required>
</div>
<div class="mb-3">
<label for="message" class="form-label">Message</label>
<textarea class="form-control" id="message" name="message" required></textarea>
</div>
<div class="mb-3 d-flex align-items-center">
<canvas id="captcha" width="200" height="80"></canvas>
<button type="button" class="btn btn-secondary" id="refresh-captcha">
<i class="fa fa-refresh"></i>
</button>
</div>
<div class="mb-3">
<label for="captcha-input" class="form-label">Enter Captcha</label>
<input type="text" class="form-control" id="captcha-input" required>
</div>
<button type="submit" class="btn btn-primary">Submit</button>
</form>