document.write('<table width="750" border="0" align="center" cellpadding="0" cellspacing="0" bgcolor="#DFE7F2"><tr><td>&nbsp;</td></tr><tr><td><form action="body-form.php" method="post" enctype="multipart/form-data" name="form1"><table width="600" border="0" align="center" cellpadding="0" cellspacing="0"><tr><td width="72" height="30" align="left" valign="top" class="black1"><strong>Name</strong></td><td width="165" height="30" align="left" valign="top"><label><input type="text" name="name" id="name"></label></td><td width="81" align="left" valign="top" class="black"><strong>Comments</strong></td><td width="282" rowspan="2" align="left" valign="top"><label><textarea name="coments" rows="3" id="coments"></textarea></label></td></tr><tr><td height="30" align="left" valign="top" class="black1"><strong>Email</strong></td><td height="30" align="left" valign="top"><label><input type="text" name="email" id="email"></label></td><td align="left" valign="top">&nbsp;</td></tr><tr><td height="30" align="left" valign="top" class="black1"><strong>Phone</strong></td><td height="30" align="left" valign="top"><label><input type="text" name="phone" id="phone"></label></td><td align="left" valign="top">&nbsp;</td><td width="282" align="left" valign="top"><input type="submit" name="button" id="button" value="Submit"></td></tr><tr><td colspan="2" align="left" valign="top">&nbsp;</td><td colspan="2" align="left" valign="top">&nbsp;</td></tr></table></form></td></tr><tr><td>&nbsp;</td></tr></table><tr valign="top"><td height="26" colspan="3" align="center" bgcolor="#245BAE" class="black"><p><span class="whitebig"><strong>Financing Available </strong></span><span class="white"><strong>619-697-1325</strong></span><br /><span class="whitebig"><a href="http://www.emedicallending.com/eml/patients/doctors_search.aspx?name=sarosy" target="_blank" class="whitebig">emedical Lending</a><br /><span class="white"><strong>Vein &amp; Liposculpture Center, 8881 Fletcher Parkway, La Mesa, CA 91942</strong></span></span></p></p><p><a href="privacy.html" class="white"><strong>Privacy Policy</strong></a>&nbsp;&nbsp;&nbsp;<a href="http://maps.google.com/maps/place?cid=15431767906810753899&q=vein+lipo+center+san+diego&hl=en&cd=1&cad=src:ppiwlink&ei=ALU7TLSWLIT4tQO745GfDQ&sig2=fCXL0O_09f-ey4IpazM-Ew&dtab=2&action=open" class="white"><strong>Write a Review</strong></a>&nbsp;&nbsp;&nbsp;<a href="http://maps.google.com/maps/place?cid=15431767906810753899&q=vein+lipo+center+san+diego&hl=en&cd=1&cad=src:ppiwlink&ei=ALU7TLSWLIT4tQO745GfDQ&sig2=fCXL0O_09f-ey4IpazM-Ew&dtab=0" class="white"><strong>More Info</strong></a></p></td></tr>');