The values in your <input>-fields can be sent with your email with the mail() function. Example:
echo "<form action='xx.php' method='post'>";
echo "<input type='text' name='test' size='12'>";
echo "<input type='submit' name='sub' value='send me!'>";
echo "</form>";
if($sub){
$emess = " Message: $test
$ehead = "From: Webmaster survey\\r\\n";
$subject = "You have a new php-mail message";
$mailsend = mail ("email@receivers_adress.com","$subject","$emess","$ehead");
}
This is written pretty on the fly, so I'm sure there are better ways. Read up on the
mail()-function