send an email which look like the form

Basically the client wants the email they receive to look like the original form, you do not need to change the actual form([login to view URL]) itself this is just the email that is sent out needs to be formatted the same as the template(Health History [login to view URL]) I've attached. [login to view URL] is the form, and it's uses HTML arrays - You need to be familiar with that. Health History [login to view URL] is the template file, the email should look very similar to this.