Let Leads Self Identify In Email

I was hoping to add in some sort of field or form in the last email of a nurture campaign to allow leads to self identify what their industry is. This way we could use the information to have them flow into another stream that is specific to their industry, Is there a way to embed a form on emails or does anyone know any other ways to accomplish this? Note - since there are other CTAs on this email, we don't want to send them off an email to a landing page.

Thanks!