Multiple Choice Question Format with Write-in Box for Each Choice

I would like to use a multiple choice question format, that includes a write-in box on the right of each choice. This would allow a predetermined choice to have a write-in box similar to how the "other" option does.

I don't believe that this format is currently an option on ZOHO Survey; however, it would be a very helpful feature to add to the ZOHO survey platform.

An example of when this would be used is:

When targeting a specific demographic and asking about their medication use. Commonly used medications would be listed as a choice and survey participants would write in t heir daily, dose total in mg where applicable (in box to the right of medication name).