Layout of confirmation box once appointment made

Hi

Help so far has got me to where I need to be, thanks. Just one more little niggle though. If you take a look at my appointments page:
http://www.janicebenningsolutions.co.uk/make-appointment/
you will see that when you have selected an appointment, the boxes that contain the name, email and phone number to be filled in are too long. I suspect this may be a conflict with my theme, but I wondered if you had any idea before I go to the theme makers with this?
Thanks