Developer Needed to Create Web Survey w/Mobile Video & Audio Submission (Quick turnaround)

We need a developer to create a simple survey form - for mobile web browsers, not app. The survey is fairly straightforward but would have one more complex feature: the ability of users on iOS and Android to submit video and audio responses, from their phone, to the survey. The basic survey format will be something like Page 1: user info First Name Last Name Email Phone Checkbox for privacy agreement Button: next Page 2: survey question 1-10 question Page 3: survey question Multiple choice question Page 4: Audio or Video submission User is asked to respond to question with a video (from phone) or audio (press button to record and submit audio) Page 5: Audio or Video submission User is asked to respond to question with a video (from phone) or audio (press button to record and submit audio) SUBMIT Page 6: Thank you page All info comes back to database created by engineer. That's it. Have you done this before and can you do it again quickly?