Create a spreadsheet, share it as a form, choose who you want to email that form to and Google Docs will collect and tabulate that information in a spreadsheet.
I created a form in a minute. Fill it out if you would like to give it a try (no personal info or Google account is required). I’ve set it so that responses will be displayed in the form so if you fill it out and go back to the form you’ll see your response. This info also gets added to a spreadsheet that I’ve made public in my Google Docs account.
Dan Schellenberg has created a screencast on how to create a form with Google Docs.
Google Docs adds Forms by Clint Lalonde is licensed under a Creative Commons Attribution 4.0 International License.