Hi, I have a setup already like the survey you linked to, which I can amend to include the questions you want to ask.
All I would need are the questions, and what you would like done with the answers... I assume you would like them inserted into a database and then to be emailed every time someone completes the survey?
I do this sort of thing on a daily basis as a web developer, so I can have it ready in a matter of hours, database included and all nicely formatted in the design. I would also modularise the code, so that you could include it on any website you wanted, or even resell it :-).
Looking forward to hearing from you.
Kind regards,
Will