Create High convertion landing Page for a Pilates Studio

Hi Guys, We are one of the premier Physiotherapy practices in the Newcastle region in Australia and we are about to launch a Brand New Pilates studio. [login to view URL] I need a simple high converting landing page for my FB and PPC ads to promote our initial offer (Free Initial Physio Assessment) and to encourage them to fill out the form to schedule an appointment. Fields for the form are: First name, Last name, email and phone (no need to add country code) I have attached the text for the page, obviously you can take key points for the page if you think it is to much. They have a quick thank you page that tells them that our staff will be in touch to schedule and appointment. I am using Infusionsoft so I can send you the code to use in the form, or if it is too much trouble, just send the details to an email address. We can discuss. My intension is to embed the page in our website, so HTML code would be great. I am uploading our logo and the text.