VBA userform

Hello,

I don't know if this is too complicated for Word. I am trying to make a form with Word 2003 in which a module pops up with a list of check boxes. The user then selects thier desired check boxes after which a text box on the document is filled in. For example, when the user checks the boxes labeled 'swimming' and 'running', the text box in the form enters the text "The patient participates in swimming. The patient participates in running." Thanks so much for your help!!

~Jennifer