"Contact Us"… but only if you meet certain criteria

Hi All,

I’m looking for a plugin that allows people to contact us IF they meet certain criteria.

EG,

– if people are from certain regions in the world they can contact us and are, upon clicking “send”, directed to a Thank you for contacting us page.
– those who do not meet the criteria (because of where they’re from, say) are diverted to another page.

Does something like that exist?

Thank you, T