I need a simple Wordpress website that sends user to a Docusign

I need the user to answer a set of questions on a Wordpress website that will be sent to an email address. After they fill out the the questions the website visitor will be asked to complete a Docusign. I would like some of their answers to be pre-filled out in the Docusign. Here is an example of the questions... First Name: John Last Name: Smith Email Address: email@[login to view URL] Home Phone: 7085551212 Alternate Phone:  7085551212 Address: 1806 Ave City: Los Angles State: CA Zip: 95350 IP Address: 172.**.**.*** Claim Type: Discrimination How Employment Ended: Left Voluntarily Start Date: Mar 2017 End Date: Jul 2017 Employer Name: ABC Buffet Employer Phone: 7085551212 Employer State: CA Job Title: Server Union or Government Employer: No Has Attorney: No Severance Agreement: No Sued by Employer: No Other Employees Affected: Yes Notes: Being called out by my race. "The Black man" being shamed for listening to gospel music.