Embedded form to collect data

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As the website manager of a charity using RE NXT I have been asked to add a very simple contact form to our website which will be a one question survey of existing constituents. I have access to online express for payment and sign up forms, but is there any way of creating an embedded web form with customisable fields that sends data to NXT? This could either be a tool to create a shortcode or javascript, as online express does, or an extension for Contact Form 7 which we use on the site. We'll also consider purchasing an add-on to do this. It seems such a simple thing but I can't find a solution - does anyone have any ideas?
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