Your Name Phone Number
Are there any chronic diseases? --- Are there any chronic diseases? ---yesNo
Your Age Please choose the age18 - 2525 - 4040 - 70
you chose the age { 18 - 25 } and the total price is :
you chose the age { 25 - 40 } and the total price is :
you chose the age { 40 - 70 } and the total price is :
Your name Phone number Are there any chronic diseases? --- Are there any chronic diseases? ---yesNo
Number of people of age 1 - 17 years
Number of people of age 18 - 30 years
Number of people of age 31 - 40 years
Number of people of age 41 - 50 years
Number of people of age 51 - 55 years
Number of people of age 56 - 59 years
Calculate total amount in JOD