Custom Landing page/Webpage design

I am in need of an experience designer who can design a custom landing page for surveys. In the landing page process I want to ask them a question first and I will then ask a second question. I do not want the form to refresh. The form will only submit after we have collected the name and email on the last step. I want each form to populate as each question has been answered. Below are the two pages that I need a designed into one page along with the email capture form on the same page. [login to view URL] [login to view URL]