What is JotForm?
JotForm is a free online form builder which helps you create online forms without writing a single line of code. No sign-up required.
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I think will be possible to create a form as you're requesting, what I would suggest you is to first take a look to our templates page where you could find a form with the layout you need: https://www.jotform.com/form-templates/
I have also created a sample form that you may clone, find the form on this link: https://form.jotform.com/63407787093970
This guide will help you to clone a form: How-to-Clone-an-Existing-Form-from-a-URL
On my form I used the matrix field, you will find it under the survey fields:
Please if you have any question, let us know.