Contact Page code

I am looking for some code for a contact page. I want to about 10 multiple choice questions. Maybe even a contact page template would work. Can some point me to something I may be able to use?

Thanks!

 

There are numerous tutorials online. If you want it done in PHP, I could do it for you for $15.00.

 

Would it be easy enough for me to edit if I wanted to change some of the questions around later on?

 

assuming you built it for me that is