Add other form fields to the testimonial

I would like the ability to be able to at least display the company name on a line below the job title/tagline field in my testimonial. Taking this a step further, would it be possible to fully customize what form fields and labels appear on the testimonial and even which lines they appear on?

As an example:

Line 1 [Name] Label Off
Line 2 [Job Title] Label Off

Line 3 [Company] Label Off, [Department] Label Off
Line 4 [Custom field 1]Label ON

Line 5 [Testimonial]

Line 6 [Rating]

Line 7 [Date]