document.write('<table width=100% border=0 cellspacing=0 cellpadding=0>');
document.write('<form name=form200 method=post action=/func/wzdc.asp target="_blank">');
document.write('<tr>');
document.write('<td align=center><table width=98% border=0 cellspacing=0 cellpadding=0><tr><td>你对早泄的看法？<br><input type=radio name=r200 value=1>觉得丢人没面子<br><input type=radio name=r200 value=2>也是病吗 没什么<br><input type=radio name=r200 value=3>不声张自己治疗<br><input type=radio name=r200 value=4>求人帮忙尽快治疗<br><input name=dc_id  type=hidden value=200><input name=dc_number  type=hidden value=4><input name=dc_type  type=hidden value=1></td></tr></table></td>');
document.write('</tr>');
document.write('<tr>');
document.write('<td>');
document.write('<table width=100% border=0 cellspacing=0 cellpadding=0 height=25><tr><td width=50% align=center><input name=imageField type=image src=/func/images/dc_tj.gif width=40 height=18 border=0></td><td width=50% align=center><a href=/func/ck_zldc.asp?dc_id=200 target="_blank"><img src=/func/images/dc_ck.gif width=60 height=18 border=0></a></td></tr></table>');
document.write('</td>');
document.write('</tr>');
document.write('</form>');
document.write('</table>');