Create a repair system on Prestashop website

You must be familiar with Prestashop! Require a 'book a repair' form to be created. Client is presented on the left hand side with tick boxes that describe the faults and he has to click one or as many as he wants. On the right hand side, there are fields to be filled: Name, Phone number, Email address, Brand of board, Model/Wheel Size, When did the fault start?, Is there anything that makes it worse?, Describe fault fully. And then a send button. This sends an email to us, with the above information. MUST BE COMPLETED TODAY!