How to create a form that will connect buyers to the stylist (form example given below)

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Hi everyone! 

I was wondering if there any apps or other features on Shopify which I can use to create a from like this. please go through the link below

The Store using this features: or

Features that I want for my store: 

Stylist Finder (This is will be a feature (form)on the website that will connect buyers to the stylist)

- choose a city (US &CAD)

- Choose a service

- Leave your email

- And we send you the stylist's bookings info


Looking forward to finding the solution.