document.write("<table width=\"100%\" border=\"0\" align=\"center\" cellpadding=\"2\" cellspacing=\"1\">");
document.write("<form action=\"http://www.fx120.net/AdvNoteBook/SendMsg.Asp?UserID="+userid+"&ctype="+ctype+"\" method=\"post\" name=\"myform\" target=\"_blank\">");
document.write("<tr bgcolor=\"#FFFFFF\"> ");
document.write("<td width=\"80\" align=\"right\">主　　题：</td>");
document.write("<td colspan=\"3\"> <input name=\"title\" type=\"text\" id=\"title\" size=\"40\" maxlength=\"38\"></td>");
document.write("</tr>");
document.write("<tr bgcolor=\"#FFFFFF\"> ");
document.write("<td width=\"80\" align=\"right\">姓　　名：</td>");
document.write("<td> ");
document.write("<input name=\"name\" type=\"text\" id=\"name\" size=\"20\" maxlength=\"18\">*</td>");
document.write("<td width=\"80\" align=\"right\">性　　别：</td>");
document.write("<td><input name=\"sex\" type=\"radio\" value=\"男\" checked>男 <input type=\"radio\" name=\"sex\" value=\"女\">女</td>");
document.write("</tr><tr bgcolor=\"#FFFFFF\"> ");
document.write("<td width=\"80\" align=\"right\">年　　龄：</td>");
document.write("<td><input name=\"age\" type=\"text\" id=\"old\" size=\"20\" maxlength=\"18\"></td>");
document.write(" <td width=\"80\" align=\"right\">婚姻状况：</td>");
document.write("  <td><input name=\"marry\" type=\"radio\" value=\"未\" checked>未 ");
document.write("<input type=\"radio\" name=\"marry\" value=\"已\">已</td></tr>");
document.write("<tr bgcolor=\"#FFFFFF\"> ");
document.write("<td width=\"80\" align=\"right\">电子邮箱：</td>");
document.write("<td><input name=\"email\" type=\"text\" id=\"email\" size=\"20\" maxlength=\"50\"></td>");
document.write("<td width=\"80\" align=\"right\">电&nbsp;&nbsp;&nbsp; 话：</td>");
document.write("<td> <input name=\"tel\" type=\"text\" id=\"tel\" size=\"20\" maxlength=\"20\">*</td></tr>");
document.write("<tr bgcolor=\"#FFFFFF\"> ");
document.write("<td width=\"80\" align=\"right\">联系地址：</td>");
document.write("<td colspan=\"3\"><input name=\"address\" type=\"text\" id=\"address\" size=\"40\" maxlength=\"40\">*</td>");
document.write("</tr><tr bgcolor=\"#FFFFFF\"> ");
document.write("<td width=\"80\" align=\"right\">邮　　编：</td><td colspan=\"3\"><input name=\"postcode\" type=\"text\" id=\"postcode\" size=\"20\" maxlength=\"18\">*</td>");
document.write("</tr><tr bgcolor=\"#FFFFFF\"> <td width=\"80\" align=\"right\">以往病史：</td><td colspan=\"3\"><textarea name=\"history\" cols=\"50\" rows=\"5\" id=\"history\"></textarea>");
document.write("</td></tr><tr bgcolor=\"#FFFFFF\"><td width=\"80\" align=\"right\">主要症状：</td>");
document.write("<td colspan=\"3\"><textarea name=\"main\" cols=\"50\" rows=\"5\" id=\"main\"></textarea></td>");
document.write("</tr><tr bgcolor=\"#FFFFFF\"><td width=\"80\" align=\"right\">问　　题：</td><td colspan=\"3\"><textarea name=\"question\" cols=\"50\" rows=\"5\" id=\"question\"></textarea>");
document.write("</td></tr> <tr bgcolor=\"#FFFFFF\"><td colspan=\"4\" align=\"center\"> <input type=\"submit\" name=\"Submit\" value=\"提交\" onClick=\"return ck();\"> &nbsp;&nbsp;&nbsp; <input type=\"reset\" name=\"Submit2\" value=\"重填\">&nbsp;&nbsp;&nbsp;");
document.write("</td></tr></form></table>");