Insert details in database

Question

Hi,

 

I have one page with topic,question and related options and button for next.

I want to insert question and related selected answer in database when i click on button

 

 

Retail Store Evaluation : topic

1-	Stores are conveniently located?
strongly agree agree disagree strongly disagree
2-	Store atmosphere and decor are appealing?
strongly agree agree disagree strongly disagree
3-	A good selection of products was present.
strongly agree agree disagree strongly disagree

I am not getting please help me in terms of concept....