MS Access Database

I need an Access database written rather quickly I have added a file showing three screens from my customer. This will be a patient database for an anesthesia office. There will be no billing or any money tracked. They are interested in keeping demographic data only. There will be three main tables and several lookup tables. The three main tables will be patient information, referring doctor information, and insurance company information. For referring doctor and insurance company, the data will be only contact information. The attached file shows notes in several places. These notes are very important to them. They need notes for patient, billing, referring doctor, and insurance company Most of the information on the second and third pages will not be used, it is only there to show billing and patient notes. The following is a note from my customer: On first page, don't need Country; the binoculars button is for employer; don't need date after status; don't need Doctor; sometimes they do have 2 insurances so need to be able to put more than one in. as far as the other 2 pages; we just need somewhere to make our notes, etc. Doesn't have to be divided up between financial, appointment, etc. Just notes that we can pull up and add to. They have data in an existing program that they are losing access to in a few weeks. So I will need preliminary database in just a few days so it can be tweaked and worked on over the next weeks or so. I am a pretty good database designer myself so communication should not be an issue. One note. I do NOT want a solution using the access dashboard. I want something better. Also please note their requirement that it have the ability to assign two insurance companies. Anywhere there is a binocular button that is a lookup table. Sorry about the PDF. They sent gif files and I just converted them. Please let me know if you need to see the original gif's