Looking for a form of sorts...

[midgetgrimm]

Hello,

What I am looking for is a mod where I can have a form that has:

Title: User inputted title here
Game: User inputted game title here
Likes: large area user inputted text
Dislikes: large area user inputted text

Then some select options:
Option 1 Where if user selects box it will echo that options title underneath the 'dislikes' area
Option 2 "
OPtion 3 "

Then when user was done it would be posted in that forum with title, game, likes, dislikes etc
Also maybe an option to post it in individual forums via drop down box to choose the forum it shall go into.

I know there are a couple of form mods, but none looked they could do what I need otherwise I'm too stoned to notice. Any help is greatly appreciated and paid forward.