364356 ONE Page web site 3

Hi , I have a quick 1 page pharmacy website . ( although it is a pretty simple project , i am getting those inexperienced programmer who just waste my time . it is just one page , and what i need is listed below) I will give you the picture to use in the background . on this page we will have our name , contact info , hours , services , .. also an online order form where patients can fill their name , tel , prescription number or name , pick up or delivery , and a notes field . make all fields optional. this form will send email to refill at [login to view URL] also a logo for the pharmacy name [login to view URL]