Joe, have you tried
....placeholder="I am interested in: '.get_the_title().' "....
also you don’t need all those php’s. The code can be cleaner, easier to read. One can do either:
<?php
echo '<form action="' . esc_url( $_SERVER['REQUEST_URI'] ) . '" method="post">';
echo '<h5>';
echo 'Ask a question <br/>';
?>
etc
or
<form action="<?php echo esc_url( $_SERVER['REQUEST_URI'] );>" method="post">
<h5>Ask a question </h5>