<div class="pageform">
<form>
<input type="text" name="name" required placeholder="Ваше имя">
<input type="text" name="phone" required placeholder="Ваш телефон">
<input type="hidden" name="urlImg" id="urlImg" value="[[~[+docid+]]]"/>
<input type="submit" value="Отправить">
</form>
</div>