ASP Online Heart Disease Questionnaire

I need someone to create an online questionnaire using ASP. This questionnaire will have the following set of questions: Age: years Gender: Female Male Total Cholesterol: mg/dL HDL Cholesterol: mg/dL Diabetes: No Yes Smoker: No Yes Systolic Blood Pressure: mm/Hg Then, based on this scoring chart... [login to view URL] ...the user will be fed back his/her risk of heart disease. I want this to be open source and editable. Preferably, i would like GRAPHICAL feedback, such as EASY TO UNDERSTAND graphs. The textual feedback will be provided during discussions after acceptance of the project. PLEASE USE ASP, CGI GRAPHICS if possible, and any database required. I need the code and to be able to edit it. THANK YOU! THIS IS URGENT! I NEED THIS COMPLETED BY END OF FEBRUARY 2006