// JavaScript Document
function ValidateForm(frm) {  
	var e = frm.elements;
	
	for(i = 0; i < e.length; i++) {
	  if (e[i].name == 'Name') {
	    if (e[i].value == '' || e[i].value == 'Name') {
	      alert('Name is required');
	      return false;
	    }
	  }
	  if (e[i].name == 'Phone') {
	    if (e[i].value == '' || e[i].value == 'Phone') {
	      alert('Phone is required');
	      return false;
	    }
	  }
	  if (e[i].name == 'Email') {
	    var reg = /^([A-Za-z0-9_\-\.])+\@([A-Za-z0-9_\-\.])+\.([A-Za-z]{2,4})$/;
      if(reg.test(e[i].value) == false) {
        alert('Invalid Email Address');
        return false;
      }
    }
  }
  
  return true;
}

function SubmitForm(p,d,v){
	var a;
	
	var e = v.elements;
	for(i = 0; i < e.length; i++) {
	  if (e[i].name == 'Name') {
	    if (e[i].value == '' || e[i].value == 'Name') {
	      alert('Name is required');
	      return false;
	    }
	  }
	  if (e[i].name == 'Phone') {
	    if (e[i].value == '' || e[i].value == 'Phone') {
	      alert('Phone is required');
	      return false;
	    }
	  }
	  if (e[i].name == 'Email') {
	    var reg = /^([A-Za-z0-9_\-\.])+\@([A-Za-z0-9_\-\.])+\.([A-Za-z]{2,4})$/;
		if(reg.test(e[i].value) == false) {
			alert('Invalid Email Address');
			return false;
		}
	  }
	}

	var name=v.elements[0].value;
	var phone=v.elements[1].value;
	var email=v.elements[2].value;
	var diagnosis=v.elements[3].value;
	var comments=v.elements[4].value;
	var page=v.elements[5].value;
	var referer=v.elements[6].value;
	var ip=v.elements[7].value;

   try{
     a = new XMLHttpRequest();
   } catch (e){
     try{
       a = new ActiveXObject("Msxml2.XMLHTTP");
     } catch (e) {
       try{
         a = new ActiveXObject("Microsoft.XMLHTTP");
       } catch (e){
         alert("Your browser broke!");
         return false;
       }
     }
   }
   p=p + "?name=" + name + "&phone=" + phone + "&email=" + email + "&diagnosis=" + diagnosis + "&comments=" + comments + "&page=" + page + "&referer=" + referer + "&ip=" + ip;
   a.open("GET", p, true);
   a.onreadystatechange = function(){
     if(a.readyState == 4){
       document.getElementById(d).innerHTML= a.responseText;
     }
   }
   a.send(null);
   return false;
}