Yes, but you are going to have to have some HTML knowledge to pull it off!
Here is how...
Put the following HTML in the HEADER... (some knowledge of HTML forms is going to be needed)
Note that field names must have the prefix "extra_" --- this name is stripped out when displayed to the end user. NO SPACES ALLOWED (this is an HTML rule)
Text1: <input name="extra_Text1" type="text" /><br />
Checkmark 1: <input type="checkbox" name="extra_Checkmark1" value="on" /><br />
Checkmark 2: <input type="checkbox" name="extra_Checkmark2" value="on" /><br /><br />
Dropdown: <select id="Select1" name="extra_Dropdown"><option value="Option1" selected="selected">Option1</option> <option value="Option2">Option2</option></select><br />
Radio Button:<br /><input type="radio" name="extra_radio" value="1" />1<br /><input type="radio" name="extra_radio" value="2" />2<br /><input type="radio" name="extra_radio" value="3" />3