Can you create this custom form?

Of course, I would have to be able to add the client information in the fields.  

Yes its possible to create a form like that.

For example:

https://form.jotform.com/72986346229974

You can clone the form ( and modify your copy how you like ):

How to Clone an Existing Form from a URL  

The paper has to look like the example I provided.. Can that be done?


...

This can be achieved but would require advanced knowledge with CSS. The form created by my colleague is like a barebone approach on how the form would look like when built with JotForm.

If you need it to behave in a "fill in the blanks" fashion as shown on your screenshot, you can try the following widgets:

1. Narrative Fields

2. Passage Test

Related guide: How-to-Add-a-Widget-to-your-Form