Design HTML web form page

I am looking for someone to design a professional looking web form. I have a single sample page – see attached, which is basically a form designed to capture user input. The questions on the form are grouped into blocks and the number of blocks will differ from one form to the next: Sometimes there might be 3 blocks of questions, sometimes 5. Similarly, the questions and controls within the blocks may differ from page to page. The HTML must function on a stand-alone basis, i.e. no external CSS, Jscript, font files. The reason for this is that the form should load, even if there is no connection to the internet. That also means that the user inputs will have to be saved locally, rather than submitted via an API. The page should be responsive in design and render properly on mobile devices. Assume a Chrom (or Chromium-based) browser only - no need for multi-browser support. The layout of the sample page is explained below in the attached Word document.