Hi there,
I'm Tamsyn, a freelance designer from South Africa. I can create the simple interactive form in Wix for you. I have plenty experience in Wix design and will ensure your form has full functionality according to your specifications. Bring your idea to me and I will make sure you are happy with the results!
Feel free to contact me with the details. Looking forward to working with you on this project!
Kind regards,
Tamsyn