That's definitely a job for PHP.
You set out a form in the normal way but instead of the action being a mailto to your email the action is to a process.php page which is usually used to send data to a database with a confirmation email but in your case the process would take just the completed input box data and display a new page, either as the form without the empty input boxes or a new layout.
There's a separate board for PHP questions as I can only do the database part.
Code downloaded to my PC will be deleted in due course.
WIN7; IE9, Firefox, Opera, Chrome and Safari for Windows; screen resolution usually 1366*768.
Also IE6 on W98 with 800*600 and IE8 on Vista 1440*900.