Excel macro to extract Word form data into Excel

Hello all,

I have a word doc that has a form in it. The form may have any number of fields (boxes) to type text answers into, or be a drop down list to select an answer from. I need an excel macro that extracts all data from the form, but with every five fields starting a new row in excel. So all data from the form will appear within 5 columns in an excel spreadsheet.

field 1 field 2 field 3 field 4 field 5
field 6 field 7 field 8 field 9 field 10
etc

Is that possible? I have had no luck to do it myself.

Sample form attached, thank you.
____________________________

sample.doc