What's the best way to make a relatively complex contact form?

[cgl102770]

I have a client who's doctor, and he needs a patient referral form. It won't ask for sensitive information, so it doesn't need to be secure, though the fields like "social security number" may be added later. The challenge is, that the forms are unique in their layout, so I can't use the online formmakers like jotform or wuffoo. For example, one area will have 7 vertical checkboxes on the left, with a header, and one checkbox on the right, with a header, and one of the 8 total checkboxes is required. Impossible to do with any online formmaker I've found.
So, I'm trying to find the best way to create this for a web designer with a solid knowledge of html but little coding knowledge beyond that. This page seems like a good start, though I'm a little unsure which of these is best, or if there are even better alternatives:
http://www.webresourcesdepot.com/16-free-ajax-contact-forms-for-a-better-user-experience/

Thank you for any suggestions!