Website Survey and PDF Summary

I want to create a survey on my website that will allow clients to answer several questions and have them weighted based on their responses and generate a summary to assist in prioritizing needs. The answers to their questions and summary should be e-mailed to me and the summary to the client. I have the questions and the weighed values as well as the text to appear in the summary. I would like it to be graphically appealing for both the survey and summary as well as include my logo, e-mail, address and phone numbers on both the survey and summary.