How can i achieve this , sending by user preference

Add a Page for Employee to Send a General Message with additionlal Selection Drop down such as Recomendation, Suggestion, Concern, Feedback, Others with Text Area. No Recomendation / Approving is Required and this should be send to HR, Reporting Authority, Management. A Check Box should be provided to mark to Avoid the message to be sent to the Reporting Authority and HR.