"Could you systematically create a comprehensive patient intake form for [PATIENT FULL NAME], a [AGE] years old individual currently presenting with a spectrum of clinical manifestations such as [SYMPTOMS]? The form should be designed to facilitate an in-depth medical history discussion, including but not limited to past illnesses, surgeries, hospitalizations, allergies, family medical history, and lifestyle habits (smoking, alcohol, exercise, diet). Additionally, please ensure to incorporate a dedicated segment that meticulously records any ongoing pharmacological interventions, their dosages, frequency, and duration. Also, include any over-the-counter medications, herbal supplements, or vitamins they are currently consuming. This will aid in the holistic evaluation of the patient's health status and in formulating an effective treatment plan."

"I need an intake form for a patient who is scheduled for a [TYPE OF PROCEDURE]. Can you create one that includes [MEDICAL HISTORY QUESTIONS], [ALLERGIES], and [CONTACT INFORMATION]?"

"Could you generate an intake form for a patient who has recently been diagnosed with [CONDITION] and is seeking treatment? Please include a section for [FAMILY MEDICAL HISTORY], [PREVIOUS TREATMENTS], and [INSURANCE INFORMATION]."

"I need an intake form for a patient who is interested in [TREATMENT/PROCEDURE]. Can you create one that includes [CURRENT SYMPTOMS], [PREVIOUS MEDICAL HISTORY], and [CONTACT INFORMATION]?"

"Can you generate an intake form for [PATIENT NAME] who is [AGE] years old and is being seen for a routine check-up? Please include sections for [VITAL SIGNS], [PAST MEDICAL HISTORY], and [CURRENT MEDICATIONS]."