Creation/revision of data collection forms in php

Want to create a form for data collection, layout ready. https://prnt.sc/se2z80

The website on Worpress, but integration is not required.

Implementations are two:

1. To modify a form in PHP that started another programmer. Worked on a project a programmer, but after a couple of weeks after the appearance of coronavirus gone.

2. To reimplement this form.

The form contains all the data, then it generates or ekselevskoy vordovsky file with these data.

Specify the price and terms, thank you!