Without using mirrors (or, less likely, prisms, fiber optics, or exotic non-photographic lenses), there's no way in one simple exposure, but it is trivial to combine two different shots into a single image. This single file could then be submitted to an online form.
I wouldn't recommend that from a UX perspective, since it's a big hoop that many non-technical users won't be able to surmount, but it's not hard for anyone who knows their way around an image editor.