How to have text entry within multiple select

Hi,

I am creating a form for home care workers.  They need to indicate which of 3 items have been installed in a home and to enter the locations.  The form will look like this:

Home environment and modification:

_ Grab bar installed at ______________

_ Ramp installed at ___________

_ Kerb seen at __________

They should be able to select none or any number of the above and fill in information for the ones they select.  How do I implement this?  Thank you.

I'm afraid we do not have a field or a widget that has the feature you required in your form.

But, we can probably have separate fields where your respondents can enter the location of the option installed.

We can use CSS to style it the way you want it to. However, data on the submissions page will also be separated.

Thank you!