Code writer to add to one form

Need web code writer to add some items to the codes of an already-existing form that is on this site: <[login to view URL]> This is not my site, but I am agent for the company to obtain clients through the one million lawyers in the US. What you would do is to copy the view source codes of the form on the above page. Then we need another submittable form that will solicit the same information plus the following toward the bottom of the form: --------------------------------------- If you are working with an attorney and want the attorney to handle this evaluation for you, please enter the attorney's information: Name of Attorney E-mail of Attorney Mailing Address of Attorney City of Attorney State of Attorney **Referred by Zeigler Elder Care** -------------------------------------- Then when SUBMIT is hit, it will send all information from the original form and the above to the same place it sends now plus also to <ZeiglerElderCare@[login to view URL]> There will be two recipients of the form info instead of just one.