Create Fillable PDF from Template

I need a scanned document converted into a fillable PDF. Essentially recreate the document.

Requirements:
- Use provided scanned document as template
- Include fillable text fields and checkboxes
- No automatic calculations needed

Replace formattring “ASPEN” with “Advanced Medicals”

Colour scheme is
black for text (or white if over coloured banner)
Banners to be maroon/mauve
Other headings dark blue.

Ideal Skills and Experience:
- Experience with PDF editing software
- Attention to detail for accurate field placement
- Ability to maintain formatting from scanned document