Create Excel Form

I would like to create an excel form that will enable me to list specific instructions to a patient about which drop to take to which eye on specific calendar days. There may be one or multiple drops, and the schedule will vary by day and frequency. An input screen will allow me to enter: -the patient's name -the starting date -the medication ---there may be one or many medications for one or both eyes. ---the program must allow me to input as many medications as necessary ---the program must allow me to indicate for how long a given frequency is maintained ---the program must be able to show on a day by day illustration when the frequency changes and for how many days I created the examples just to illustrate my idea. Different designs are welcome I would like to be able to print and/or to email this form. The email must present the final sheet as an attachment AND in the body of the email I currently use Microsoft Office 2010 and 2016