Check Boxes on click and default value please help

[Jeremy0028]

I been puzzleing over this. I'm designing an insurance database i have a table and form called patient info. On the patient info form i have the following. Last Name, First Name Address, city, State and Zip. which is in the patient info table. I also have a form called insurance which has the following 1st on the top i have four check boxes set as yes and no which are Self, Spouse, Child, Other, I also have the following as text boxes Insureds Last Name, Insureds First Name, Insureds Address, Insured City, Insured State, Insured Zip, Insured Phone, this to is on the patient table. What i want the check boxes to do is when i click self it will copy all the info from the patient info form such as last name first name etc etc to the insurance form. I tried several different ways but every time i change the insurance form it also changes the patient info form which i dont want. I want the user to be able to edit the insurance form without changing the patient info form.