please provide answer with screen shot for the out put it is important to give code with screen shot and do not hand wrting

Write an HTML file that creates the following web page.

Important notes:

You should have to copy and paste the HTML script as your answer to this question. DONT take a screenshot for your HTML script. It must be an editable script.

Take a screenshot of your output web page and paste it as a part of your answer.

Make use of labels and appropriate input types.

The dropdown menu has the options: Tooth Extraction, Grafting, Restoration, Cosmetic Dentistry, and Implants

Dental Ireatment Informed Consent Form Patient information * denotes mandotory Name*: Age : Email Address: Date of Birth*: Type of Dental Procedure* : Discount Coupon code: Terms and conditions* I allow and authorize the clinic to perform this procedure to me. I understands the side effects of the medications given to me. I understand that I am not allowed to eat or drink 4-6 hours before the procedure