function validate_required( field ) {
	with ( field ) {
		if ( value == null || value == "" ) {
			$('E-'+name).style.display = 'block';
			return false;
		} else {
			$('E-'+name).style.display = 'none';
			return true
		}
	}
}
 
function validate_form( thisform ) {
	with (thisform) {
		var success = true;
		if ( validate_required( Name ) == false ) { success = false; }
		if ( validate_required( Phone ) == false ) { success = false; }
		if ( validate_required( Email ) == false ) { success = false; }
		return success;
	}
}
function writeAppt( GUID, returnURL ) {
document.write('<style type="text/css">@import url(/js/jscalendar/calendar-blue.css);</style>');
document.write('<script type="text/javascript" src="/js/jscalendar/calendar.js"></script>');
document.write('<script type="text/javascript" src="/js/jscalendar/lang/calendar-en.js"></script>');
document.write('<script type="text/javascript" src="/js/jscalendar/calendar-setup.js"></script>');
document.write('<form class="a-form" name="test" action="http://patientdocs.com/service/appointment.php" method="post" onsubmit="return validate_form(this)">');
document.write('	<input type="hidden" name="GUID" value="' + GUID + '"/>');
if( typeof returnURL != 'undefined' ) {
	document.write('	<input type="hidden" name="returnURL" value="' + returnURL + '"/>');
}
document.write('	<div id="E-Name" class="a-error">*Name is required.</div>');
document.write('	<div class="a-div">');
document.write('		<div class="a-label">Name</div>');
document.write('		<input class="a-input" type="text" name="Name"/>');
document.write('	</div>');
document.write('	<div id="E-Phone" class="a-error">*Phone is required.</div>');
document.write('	<div class="a-div">');
document.write('		<div class="a-label">Phone</div>');
document.write('		<input class="a-input" type="text" name="Phone"/>');
document.write('	</div>');
document.write('	<div id="E-Email" class="a-error">*Email is required.</div>');
document.write('	<div class="a-div">');
document.write('		<div class="a-label">Email</div>');
document.write('		<input class="a-input" type="text" name="Email"/>');
document.write('	</div>');
document.write('	<div class="a-div">');
document.write('		<div class="a-label">Date and Time</div>');
document.write('		<input class="a-input" style="width:100px;" type="text" id="RequestedDate" name="RequestedDate"/><select name="RequestedTime" style="width:90px;">');
document.write('			<option>8:00am</option>');
document.write('			<option>9:00am</option>');
document.write('			<option>10:00am</option>');
document.write('			<option>11:00am</option>');
document.write('			<option>12:00pm</option>');
document.write('			<option>1:00pm</option>');
document.write('			<option>2:00pm</option>');
document.write('			<option>3:00pm</option>');
document.write('			<option>4:00pm</option>');
document.write('			<option>5:00pm</option>');
document.write('			<option>6:00pm</option>');
document.write('			<option>7:00pm</option>');
document.write('			<option>8:00pm</option>');
document.write('		</select>');
document.write('	</div>');
document.write('	<div class="a-div">');
document.write('		<div class="a-label">Urgency</div>');
document.write('		<select class="a-input" name="Urgency">');
document.write('			<option selected>Regular Visit</option>');
document.write('			<option>Experiencing Pain</option>');
document.write('			<option>Emergency</option>');
document.write('		</select>');
document.write('	</div>');
document.write('	<div class="a-div">');
document.write('		<div class="a-label">Comments</div>');
document.write('		<textarea class="a-input" name="Comments"></textarea>');
document.write('	</div>');
document.write('	<div class="a-div">');
document.write('		<center><input type="submit" value="Request Appointment"/></center>');
document.write('	</div>');
document.write('	<div class="a-div" style="text-align:left;">');
document.write('		<a href="http://www.patientdocs.com/"><img src="http://www.patientdocs.com/img/home/poweredby.gif"/></a>');
document.write('	</div>');
document.write('</form>');
}