document.write('<table width=100% border=0 cellspacing=0 cellpadding=0>');
document.write('<form name=form8 method=post action=/func/wzdc.asp target="_blank">');
document.write('  <tr> ');
document.write('    <td>　　如果你有一次整容的机会，你最想整容的部位是？<br><input type=checkbox name=ck81 value=1>割双眼皮<br><input type=checkbox name=ck82 value=2>隆鼻<br><input type=checkbox name=ck83 value=3>除皱<br><input type=checkbox name=ck84 value=4>丰乳<br><input type=checkbox name=ck85 value=5>下颌骨切除（瘦脸术）<br><input type=checkbox name=ck86 value=6>拒绝手术<br><input name=dc_id  type=hidden value=8><input name=dc_number  type=hidden value=6><input name=dc_type  type=hidden value=2></td>');
document.write('  </tr>');
document.write('  <tr> ');
document.write('    <td> ');
document.write('      <table width=100% border=0 cellspacing=0 cellpadding=0 height=26><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%><a href=/func/ck_zldc.asp?dc_id=7 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>');