the problem im having is when you fill out your details

Hi, the problem im having is when you fill out your details to make an appointment on my site with a samsung galaxy phone , when you click confirm details and it comes up with a error message- The page at instituteofsacredenergy.com.... Something wrong about the submitted email.
Ive tried different emails but get the same error. I pad, I phone and pc work no problem at all. This is the link to the page http://instituteofsacredenergy.com/make-an-appointment-2/
Hope you can help
Kind Regards
Helen