<p>¿pregunta1?</p>
<input type="radio" value="1" name="r_1" />A<br />
<input type="radio" value="2" name="r_1" /> B<br />
<input type="radio" value="3" name="r_1" /> C<br />


<p>¿pregunta2?</p>
<input type="radio" value="1" name="r_2" />A<br />
<input type="radio" value="2" name="r_2" /> B<br />
<input type="radio" value="3" name="r_2" /> C<br />


<p>¿pregunta3?</p>
<input type="radio" value="1" name="r_3" />A<br />
<input type="radio" value="2" name="r_3" /> B<br />
<input type="radio" value="3" name="r_3" /> C<br />

var x=new Array(3);
x [0]="j";
x [1]="k";
x [2]="i";
x [3]="t";

function recargar(){


document.location.href = document.location.href;

}

function dato(form){


var c=document.getElementById("myCanvas");
var ctx=c.getContext("2d");




if(pri<50 && prd<50 && panal<50 && pan<50){

if (form.voto[0].checked == true)
    { pri++;contpri=pri;estadistica.conteopri.value=pri;


}


if (form.voto[1].checked == true)
    { pan++;contpan=pan;estadistica.conteopan.value=pan;   }


if (form.voto[2].checked == true)
    { panal++;contpanal=panal; estadistica.conteopanal.value=panal;   }


if (form.voto[3].checked == true)
    {prd++;contprd=prd;estadistica.conteoprd.value=prd; }

}else{ pri=pri/2;pan=pan/2;prd=prd/2;panal=panal/2; }




ctx.fillStyle="#FF0000";
ctx.fillRect(0,10,pri,80);


ctx.fillStyle="blue";
ctx.fillRect(0,100,pan,80);


ctx.fillStyle="00FFFF";
ctx.fillRect(0,190,panal,80);


ctx.fillStyle="yellow";
ctx.fillRect(0,280,prd,80);





}

  

<tr><td >Nombre: <input type="text" name="textfield" /> </td></tr>
<tr><td >Correo-e: <input type="text" name="textfield" /> </td></tr>
<tr><td >Empresa: <input type="text" name="textfield" /> </td></tr>
<tr><td >Tel: <input type="text" name="textfield" /> </td></tr>