Although this is a VISUAL BASIC forum I believe you can write it out in HTML like this:

<html>
....
<form method="POST" action="[email protected]">
<input name="question1" type=text or radio...>
....
<input type="submit" value="send">
</form>
....
</html>

this will send the results to the specified e-mail address in the follow format as a ATT file:

question1=yes&question2=no

or what ever values you give to the form inputs.