If you are up for a little adventure, check out http://www.phpsurveyor.org/.
I have installed this on dreahost, and it works like a charm. Much easier way to implement the type of functionality you describe than handcrafting a buch of html forms and using some processing software (DH has one! see formmail.dreamhost.com) to send you the result via email.
Frankly, if you can find your way through the instructions to use DH’s formmail, you can probably install/use phpsurveyor.
Check it out, and Good Luck!