Printed checkboxes plugin wordpress

I use wordpress and we want to incorporate a feature.
I have not seen it anywhere yet.

Basically it is like a survey with questions and checkboxes for different questions. When you click submit you get a print out of the items you selected or the option to print. Hope that makes sense.

  1. What is your fav car?
    a -kia

I select “c” in checkbox

When i click done or submit, i get a screen shot of my selected items to be printed out
Thank you