Form builder with parameterized inline text?

I need to create a single page form with standard fields for user completion, but with inline static text that appears above the form fields which might vary.

I guess it’s something like a mail-merge functionality. Pre-filling forms fields won’t do - they wouldn’t be inline with the rest of the text.

Can anyone suggest the best form tool for this, or a neat workaround?

It would be great if you share a screenshot with an example of how the document should exactly look like.