With Zend_Form it is entirely possible to start with your form visually, and then work backwords.
This is done by removing all decorators and replacing them with a ViewScript decorator
$this->form->setDecorators( array(array('ViewScript', array('viewScript' => 'forms/aform.phtml'))));
And in that viewscript you would do something like this:
<?=$this->element->title->renderViewHelper()?>
Going with this approach, you can basically do anything you want with the form.
Another great thing about Zend_Form is that you can create custom elements which can encapsulate other stuff in them. For example, you can have an element which outputs a textarea and then some Javascript to turn it into a WYSIWYG area.