// JavaScript Document



function SubmitForma() {
	var sMsg = '';

	// check for incomplete fields
	
	if(IsEmpty(document.frmForma.insurance.value) == true){
		sMsg = sMsg + 'Please select your insurance provider\n'
	};

	if(IsEmpty(document.frmForma.firstname.value) == true){
		sMsg = sMsg + 'First Name\n'
	};
	
	if(IsEmpty(document.frmForma.lastname.value) == true){
		sMsg = sMsg + 'Last Name\n'
	};
	
/*	if(IsEmpty(document.frmForma.email.value) == true){
		sMsg = sMsg + 'email\n'
	};
*/	
	/*	if(IsEmpty(document.frmForma.address.value) == true){
		sMsg = sMsg + 'Address\n'
	};*/
	/*
		if(IsEmpty(document.frmForma.city.value) == true){
		sMsg = sMsg + 'City\n'
	};	
		if(IsEmpty(document.frmForma.state.value) == true){
		sMsg = sMsg + 'State\n'
	};
	*/
	if(IsEmpty(document.frmForma.zip.value) == true){
		sMsg = sMsg + 'Zip\n'
	};
	
	if(IsEmpty(document.frmForma.phone1.value) == true || IsEmpty(document.frmForma.phone2.value) == true || IsEmpty(document.frmForma.phone3.value) == true){
		sMsg = sMsg + 'Phone Number\n'
	};

	if(IsEmpty(document.frmForma.besttime.value) == true){
		sMsg = sMsg + 'Best Time to Reach Them\n'
	};

	var phone1 = document.frmForma.phone1.value;
	var phone2 = document.frmForma.phone2.value;
	var phone3 = document.frmForma.phone3.value;

	// if any of the fields are incomplete
	if(sMsg !== '')	{
		sMsg = 'Oops, We also need to know the following... :)\n\n'	+ sMsg;
		alert(sMsg);
		return false; // do not sumbit the form
	}
    else if ( !phone1.match(/^[0-9]{3}$/) || !phone2.match(/^[0-9]{3}$/) || !phone3.match(/^[0-9]{4}$/) )
    {
        alert('Please enter a valid phone number');
        return false;
    }	
	

	if(document.getElementById('insurance').value == 'Y')
    	{
       		
	    	setCookie('medicare','yes',1);	
    	}
	else
	{
		setCookie('medicare','no',1);
	}

	document.frmForma.submit();
	
	return true; // submit the form
}
function setCookie(cookieName,cookieValue,nDays)
{
					 		          	var today = new Date();
					 						 var expire = new Date();
					 							if (nDays==null || nDays==0) nDays=1;
					 									expire.setTime(today.getTime() + 3600000*24*nDays);
					 										document.cookie = cookieName+"="+escape(cookieValue)  + ";path=" + "/"
					 												 + ";expires="+expire.toGMTString();
		
}