Creating An Email Containing A Web Site Form

I would like to write a generalised page which creates an email
containg the (calling) HTML form complete with the user populated
data.

In this way the appearance of the email will be just like the form
elements of the form that called the generalised page together with
the completed fields.

I can see that I can caputure the (blank) calling page itself in the
email by using the CreateMHTMLBody method of CDO. I can also see how I
can retreive the individual elements of the form using Request. But is
it possible to combine the two?