// cta-left.js
document.write('<table width="100%" border="0" cellspacing="0" cellpadding="0">');
document.write('<tr>');
document.write('<td><a href="https://www.medfusion.net/secure/portal/index.cfm?fuseaction=home.login&dest=welcome&gid=7997&muuid=8849"><img src="/images/patient_portal_callout.png" width=171 height=130 border=0></a></td>');
document.write('</tr>');
document.write('</table>');
document.write('<table width="171" border="0" cellspacing="0" cellpadding="0">');
document.write('<tr>');
document.write('<td colspan=3><img src="/images/cta-box-top-qcontact.png" width=171 height=55 border=0></td>');
document.write('</tr>');
document.write('<tr>');
document.write('<td width="8" background="/images/cta-box-left.png"><img src="/images/spacer.gif" width=8 height=1 border=0></td>');
document.write('<td width="155" background="/images/cta-box-inside.png"><br>');
document.write('<table width="100%" border="0" cellspacing="0" cellpadding="0" class=boxTxt>');
document.write('<form onSubmit="return checkrequired(this)" method=post action="/ufm3/mailit.php" name="contact">');
document.write('<input type="hidden" name="recipient" value="1" />');
document.write('<input type=hidden name="subject" value="Quick Contact Form">');
document.write('<tr>');
document.write('<td class="boxTxt3"><font size="1">Name&nbsp;&nbsp;(required)</font></td>');
document.write('</tr>');
document.write('<tr>');
document.write('<td><input type="Text" name="requiredName" size="22" class=boxTxt1></td>');
document.write('</tr>');
document.write('<tr>');
document.write('<td class="boxTxt3"><font size="1">Phone</font></td>');
document.write('</tr>');
document.write('<tr>');
document.write('<td><input type=text name="Phone" size="22" class=boxTxt1></td>');
document.write('</tr>');
document.write('<tr>');
document.write('<td class="boxTxt3"><font size="1">Email&nbsp;&nbsp;(required)</font></td>');
document.write('</tr>');
document.write('<tr>');
document.write('<td><input type=text name="requiredEmail" size="22" class=boxTxt1></td>');
document.write('</tr>');
document.write('<tr>');
document.write('<td class="boxTxt3"><font size="1">Message</font></td>');
document.write('</tr>');
document.write('<tr>');
document.write('<td><textarea name="comments" cols="21" rows="4" class="boxTxt1"></textarea></td>');
document.write('</tr>');
document.write('<tr>');
document.write('<td align=center><br><input type="Image" name="Submit" src="/images/btn-submit.png"></td>');
document.write('</tr></form>');
document.write('</table>');
document.write('</td>');
document.write('<td width="8" background="/images/cta-box-right.png"><img src="/images/spacer.gif" width=8 height=1 border=0></td>');
document.write('</tr>');
document.write('<tr>');
document.write('<td colspan=3><img src="/images/cta-box-bottom.png" width=171 height=10 border=0></td>');
document.write('</tr>');
document.write('</table>');
document.write('<table width="100%" border="0" cellspacing="0" cellpadding="0">');
document.write('<tr>');
document.write('<td><a href="/cgi-bin/forms.pl"><img src="/images/cta-forms.png" width=171 height=130 border=0></a></td>');
document.write('</tr><tr>');
document.write('<td><a href="/cgi-bin/faq-q.pl"><img src="/images/cta-faq.png" width=171 height=130 border=0></a>');
document.write('</td></tr></table>');