SharePoint 2010 survey: Add additional text boxes beside choices/checkboxes?

I have a survey question which requires the user to list certain items beside each choice provided by the question.
For eg:
What are your favorite things? List names against each category
Name [Textbox]
Place  [Textbox]
Animal [Textbox]
Color [Textbox]
And the answer would look something like:
Name [Wee, Woo, Mee, Moo]
Place  [LA, Paris, Bombay]
Animal [Cat, dog]
Color [White,Black]
If anyone has any ideas to implement this or guide me to a related article or literature, that would be great!
Any help appreciated. Thanks 

Hi Ritesh,
Try utilizing IE developer toolbar/ Firebug to locate the ID of the element "Specify your own value". Mine was something like this: ctl00_m_g_2c113611_bc41_4c82_94e9_a6e253aa8444_ctl00_ctl01_ctl01_ctl00_ctl00_ctl04_ctl00_ctl01
Then go to the NewForm.aspx or EditForm.aspx of your list , insert a CEWP below the ListFormwebPart. In the <content></content> tag of your CEWP add the following script:
<![CDATA[<script src="Fullpath/jquery-1.8.3.min.js" type="text/javascript"></script>
<script type="text/javascript">
$(document).ready(function(){
$("label[for='ctl00_m_g_2c113611_bc41_4c82_94e9_a6e253aa8444_ctl00_ctl01_ctl01_ctl00_ctl00_ctl04_ctl00_ctl01']").text("Please describe");
</script>&nbsp;]]>
Save and done!
As I mentioned this is not the best way since you have to add multiple label ID's corresponding to every "Specify your own value" label that you want to change....

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    Figure 1 Checkbox Process Model
    Regards,
    John

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