I would like to send a WORD document as a on line questionnaire which would be sent back to me with the following information format.
I would have a question that people would answer by clicking on a circle and filling it in or place a check mark such as:

1. Check the circle with your response.
O This format is working well.
O This format is not working well.

OR add a check mark
_____ This format is working well
_____ This format is not working well

I would also have a free text line in the document that people could insert comments
__________________________________________________ _______________________________________________
__________________________________________________ __________________________________________________ _

How can this be done in WORD and then the answers and comments be sent back to me once the questionnaire is finished.
thanks for anyone that can help
Cardinal2