PDF form - encrypt and email

I would like a blank form to be created for me that does the following: Has a signature box for an electronic signature Will work on an iPad/Android Tablet Send a copy of the form filled in, to a specific email address Encrypt his form prior to sending As an example, if someone wants to decline getting a flu shot, I will put the middle wording in place, key in a couple of hidden fields with data regarding the type of form it is ie Flu Declination, Fit Testing etc.. The person could take a tablet, put in their name, employee number and then sign it, click submit and have a cop of the PDF form complete sent via encrypted email to a specific email address, which should be coded into the form.