Simple app for iphone/ipad and Android

Avg Bid (USD)
Project Budget (USD)
$250 - $750

Project Description:
I would like a simple app developed, ready for me to add to the app store. It has one page with a form where the purchaser will fill in about six text boxes. Also I need a picture of an outline of a body which the user will be able to circle a small part of to identify an area of the body. Once the form is complete the user needs to be able to email the information (including a copy of the body outline) to themselves and one other email address. The App does not need to store the information once the email is sent (unless it is quick and easy to create the ability to keep a record within the app). I would like it to work on iphones, ipads and android devices with people paying a small amount for the app. Please feel free to ask me more questions.

Skills required:
Android, iPhone, Mobile Phone
About the employer:
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