ok, try the following base:
questioniere.php :
<?
$db=mysql_connect("localhost","root","password") or die("Server could not be connected");
$mydb=mysql_select_db("questioniere") or die("Database could not be connected");
echo"<form method=post action=submit.php>";
echo"<b>Question 1</b>";
echo"<br>";
echo"<input type=text name=quest1>";
echo"<br>";
echo"<br>";
echo"<b>Question 2</b>";
echo"<br>";
echo"<input type=text name=quest2>";
echo"<br>";
echo"<br>";
echo"<b>Question 3</b>";
echo"<br>";
echo"<input type=text name=quest3>";
echo"<br>";
echo"<input type=submit name=options value='Submit'>";
echo"<input type=hidden name=quest1 value='$quest1'>";
echo"<input type=hidden name=quest2 value='$quest2'>";
echo"<input type=hidden name=quest3 value='$quest3'>";
echo"</form>";
?>
submit.php :
<?
$db=mysql_connect("localhost","root","password") or die("Server could not be connected");
$mydb=mysql_select_db("questioniere") or die("Database could not be connected");
echo"<form method=post action=questioniere.php>";
echo"<b>Thanks for the feedback</b>";
echo"<br>";
echo"<input type=submit name=options value='Submit'>";
$sql="insert into questions_table (quest1,quest2,quest3) values('$quest1','$quest2','$quest3');";
$insert=mysql_query($sql);
echo"</form>";
?>
hope that helps!
campsoup1988