Code One-page Web Form From Existing

Hello, there is a Web Client Intake Form here: http://comprehensiveinternet.com/contact-us that I need coded as a single web page. I don’t need the top part, shown in the attached image), but need the form all the way down to the bottom with a captha.

The form must render accurately in all browsers. As you can see the existing form is mis-aligned, particularly in IE. It needs to be spaced correctly and orderly. I will add 2-3 more checkbox items.

Page title will be Client Intake. I want to…

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