create a custom input form as an extension

I’m trying to create a form with an input (Ex: my age), and I want to display result from that input (Ex: display my name).
I want to create a form like this page https://batdongsan.com.vn/ho-tro-tien-ich/ht-xem-huong-nha

Does anyone here know what can I do to imitate the tool like that page.
Thank you all!

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