Creation of quality online interactive responsive form for use on various websites

We require the creation of an online form. The form needs to be and intelligent, interactive form that allows different questions to roll out dependent on the first question response. The form will have a maximum of 40 questions and is designed to capture new business enquiries from perspective customers. The form is not for online "quote and buy" but it needs to look and behave the same way. The best example we can provide is a link to the following online form:

https://secure.professionalinsuranceagents.co.uk/?action=pageone&combo_id=131

The form needs to look and perform in exactly the same way as the example.

Completion of the first form will lead to the creation of further similar forms so we are looking for an ongoing working relationship.

Fixed cost would be preferred but open minded.