Make Submittable Form Out Of Pdf Doc

I have attached a PDF form document called “Employee and Family Medical Questionnaire”

I need an HTML form made that looks exactly like this that can be filled out online and submitted with all of the information saved into a database.

Then there needs to be a viewer page that can bring up this information from a database and fill out this form so that it can be printed out.

This should be done in PHP/MySQL.

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