Simple Script that calculates our death date using user input

Project Description:
i want to build a website that calculates our visitor death date and display it as a digital clock counting backwards.
Visitor will input into a form some details like age, sex, habits and then when he hits calculate he ll get his death date based on those facts.
i already have the js script and the form that gathers this input data but dont know how to make the results page.
To get a better idea visit death date dot info and select the Calculate option from the top menu and see how it works.
I already have the form displayed there and the js script that is related so i need to build the results form.