Create online questionnaire using Wix

Job ID: 36204601

Budget: $30 – $250 USD

I have a 4 page questionnaire I need changed into an online form using Wix.
Output can be as a document, meaning that fields do not need to be tied into database. If that is possible, it saves some time.

The form is below. It doesn't have to be an exact match as long as it gets all the information in and has a clean interface.

This is the questionnaire: https://www.dropbox.com/s/guk1hg1g0765dxf/new%20patient%20intake%20%2Bconsent.docx?dl=0