document.write("<script language=\"javascript\" type=\"text/javascript\" src=\"http://pc.lyweile.com/statics/js/dialog.js\"></script><link href=\"http://pc.lyweile.com/statics/css/table_form.css\" rel=\"stylesheet\" type=\"text/css\" /><link href=\"http://pc.lyweile.com/statics/css/dialog.css\" rel=\"stylesheet\" type=\"text/css\" /><script type=\"text/javascript\" src=\"http://pc.lyweile.com/statics/js/dialog.js\"></script><div class=\"box\">    <h5>表单向导</h5>    <div class=\"content\"><form method=\"post\" action=\"http://pc.lyweile.com/index.php?m=formguide&c=index&a=show&formid=12&siteid=1\" name=\"myform\" id=\"myform\"><table class=\"table_form\" width=\"100%\" cellspacing=\"0\"><tbody> <tr>      <th width=\"80\"> <font color=\"red\">*</font> 姓名  </th>      <td><input type=\"text\" name=\"info[MemberName]\" id=\"MemberName\" size=\"16\" value=\"\"  class=\"input-text\"  >  请输入姓名</td>    </tr><tr>      <th width=\"80\"> <font color=\"red\">*</font> 手机  </th>      <td><input type=\"text\" name=\"info[MemberTel]\" id=\"MemberTel\" size=\"16\" value=\"\"  class=\"input-text\"  >  请输入联系方式</td>    </tr><tr>      <th width=\"80\"> <font color=\"red\">*</font> 性别  </th>      <td><select name=\'info[MemberE]\' id=\'MemberE\'><option value=\"男\" >男</option><option value=\"女\" >女</option></select>  </td>    </tr><tr>      <th width=\"80\"> <font color=\"red\">*</font> 年龄  </th>      <td><input type=\"text\" name=\"info[MemberOld]\" id=\"MemberOld\" size=\"16\" value=\"\"  class=\"input-text\"  >  请输入年龄</td>    </tr><tr>      <th width=\"80\"> <font color=\"red\">*</font> 牙齿状况  </th>      <td><select name=\'info[YaChi]\' id=\'YaChi\'><option value=\"牙齿不齐\" >牙齿不齐</option><option value=\"龅牙\" >龅牙</option><option value=\"牙齿稀疏\" >牙齿稀疏</option><option value=\"牙齿突出\" >牙齿突出</option><option value=\"牙齿拥挤\" >牙齿拥挤</option><option value=\"其他\" >其他</option></select>  </td>    </tr><tr><td></td><td><div class=\"submit ib\"><input type=\"submit\" name=\"dosubmit\" id=\"dosubmit\" value=\" 提交 \"></div> </td></tr></tbody></table></form>    </div></div>");