Single landing page needed

General information for the website: specific aspects of dentistry
Kind of development: New website from scratch
Num. of web pages/modules: 1
Description of every page/module: as above
Description of requirements/features: i need a single page which i will send potential leads to from Facebook/Google ad-words.
all the page has to do is capture their imagination and their details; with the offer of a free consultation/whitepaper
Extra notes: i need a single page which i will send potential leads to from Facebook/Google ad-words.
all the page has to do is capture their imagination and their details; with the offer of a free consultation/whitepaper

this is for two aspects of my business therefore i need two separate pages with slightly different content but a similar look/layout