This is certainly possible but is not a minor undertaking. You probably would want to start with a UserForm (a custom dialog box) to get basic information and construct your form, possibly from Building Blocks (AutoText) which has the areas you want filled in for each item.

This requires at least a willingness to dabble with vba and some understanding of Word's protected form structure.

Making Forms with Microsoft Word
Create a Simple Userform

Assuming that you are not a vba programmer and that you do not regularly manipulate Word protected forms with vba, and that you have other work to do, you are probably looking at a project that, with help and advice, will take more than 80 hours. You may just want to hire someone to do it (not me). Graham Mayor, the guy who wrote the UserForm article, might be available.