I need a website landing page building with a contact form as per the attached link

Industry: Healthcare
Kind of design: Landing page
Num. of web pages: 1
Description of every page: I need the landing page to mimic a landing page detailed below, but for it to be made up within our branding and look and feel of the site. The page must be set up so I can easily edit at a later date.

This page will be used as landing page for PPC but also needs to be set correctly for SEO so these factors need to be considered.

My website - using wordpress
www.caringforcare.co.uk

Landing page I want to mimic
http://www.trainingaid.co.uk/FirstAid-courses/
Ideas for the visual style: needs to fit the branding and style of my website
Website url: www.caringforcare.co.uk
Website information: health, social and first aid training
Urls to draw inspiration from: http://www.trainingaid.co.uk/FirstAid-courses/
Extra notes: