Building a Pop Up Box for Wordpress

I have built a woo commerce site in WordPress for an optician who wants to sell Glasses online. Could you give me a price on how much it would cost to add a feature, so when somebody clicks to purchase a pair of glasses, they would like a pop up box to appear which would let them select a few options and fill out a few additional fields, they should be able to enter the type of lenses required, for entering the prescription, selecting lens options and also for add customisations to the lenses. When this information is confirmed, the additional information should be posted to the checkout. I have attached screenshots of how it should look. I can send information for the fields that I'd like added to the page (they're no more complicated that what is there at present) 2) When selecting contact lenses, prospective customers need to be able to select parameters for lenses. Some lenses will have more parameters than others as show in the screenshots. Can you price me up on how much this would cost? How long it would take to do this? The site is live and is built in Word Press.