Simple checkbox matrix in Storyline

I am creating a series of videos after which the client wants the viewer to make choices by checking boxes in a matrix (see enclosed image).

This matrix will be embedded after each film and it should "remember" the answers that has been given in previous films, so at the final movie they can see if there is a pattern...

Are there templates available or some very simple way of creating this...? I am on a tight deadline and don't know how to do this. The course is made in Rise but I suppose I have to embed Storyline blocks?