"Where did you hear about us" survey at checkout

I would like to add the following survey to my checkout page (purrified-air.myshopify.com / purrifiedair.com):

Where did you hear about us:

Word of mouth check box

Google search check box

Other search engine check box

Amazon check box

Cat blog/website check box Name _______________________________

Another website check box Name _______________________________

Or something along these lines. I am no kind of coder. My theme is “Impulse,” a third party theme by Archetype Themes. They insist it is a Shopify issue as the check out page is where Shopify programming takes over from Impulse.

Of course, the back end of this function would have to collect answers by order number in some sort of usable format like a spreadsheet.

My understanding is that this is possible. Would appreciate any and all advice.

Thanks,

Bob Gordon, he who was chosen to rid the world of litter box odor.

Attached is a rough graphic example of what I am after.

unfortunately you cannot alter the checkout page unless you are a shopify plus member which starts at 2000 a month

Based on the attached it appears to be possible. Can anyone help with the how? I don’t know code but, with any luck, I can place detailed copy in the right place.

Can’t anybody help here? This shouldn’t be so complicated.

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