Hi Jessica,
Please email me at andrew@writeonweb.com - I can help you integrate a custom design and logic requests on nearly any template, and we can likely come up with a solution for the How did you hear about us function, and more.
I'm a Shopify Partner, with extensive experience in the Shopify platform along with HTML5, JavaScript, and CSS3 cross device and browser display issues. I can navigate any custom development code relatively quickly, and help you in the long term as well beyond display issues including data, shopify template logic, JavaScript, etc.
Best!
Andrew (Seattle based :-)