<!--

function validate()
{
	if (document.forms[0].pat_last_name.value == "")
	{
		alert("Please enter Patient's Last Name.");
		document.forms[0].pat_last_name.focus();
		document.forms[0].pat_last_name.select();
		return false;
	}
	if (document.forms[0].pat_first_name.value == "")
	{
		alert("Please enter Patient's First Name.");
		document.forms[0].pat_first_name.focus();
		document.forms[0].pat_first_name.select();
		return false;
	}
	if (document.forms[0].month.value == "")
	{
		alert("Please enter Patient's Date of Birth.");
		document.forms[0].month.focus();
		return false;
	}
	if (document.forms[0].day.value == "")
	{
		alert("Please enter Patient's Date of Birth.");
		document.forms[0].day.focus();
		return false;
	}
	if ((document.forms[0].month.value == "Apr" || document.forms[0].month.value == "Jun" || document.forms[0].month.value == "Sep" || document.forms[0].month.value == "Nov") && document.forms[0].day.value == "31")
	{
		alert("The month you selected has 30 days. Fix Patient's Date of Birth.");
		document.forms[0].month.focus();
		return false;
	}
	if ((document.forms[0].month.value == "Feb") && (document.forms[0].day.value == "30" || document.forms[0].day.value == "31"))
	{
		alert("February has 28 or 29 days. Fix Patient's Date of Birth.");
		document.forms[0].month.focus();
		return false;
	}
	if (document.forms[0].month.value == "Feb" && document.forms[0].day.value == "29")
	{
		if(!((document.forms[0].year.value % 4 == 0) && ((document.forms[0].year.value % 100 != 0) || (document.forms[0].year.value % 400 == 0)))){
		
			alert("February has 28 days. Fix Patient's Date of Birth.");
			document.forms[0].month.focus();
			return false;
		}
		
	}
	if (document.forms[0].year.value == "")
	{
		alert("Please enter Patient's Date of Birth.");
		document.forms[0].year.focus();
		return false;
	}
	if (document.forms[0].contact_last_name.value == "")
	{
		alert("Please enter Contact's Last Name.");
		document.forms[0].contact_last_name.focus();
		document.forms[0].contact_last_name.select();
		return false;
	}
	if (document.forms[0].contact_first_name.value == "")
	{
		alert("Please enter Contact's First Name.");
		document.forms[0].contact_first_name.focus();
		document.forms[0].contact_first_name.select();
		return false;
	}
	var index = document.forms[0].contact_relationship.selectedIndex;
	if (document.forms[0].contact_relationship.options[index].value == "")
	{
		alert("Please complete the Contact Relationship.");
		document.forms[0].contact_relationship.focus();
		return false;
	}
	if (document.forms[0].phone.value == "")
	{
		alert("Please enter Phone Number to Reach You.");
		document.forms[0].phone.focus();
		document.forms[0].phone.select();
		return false;
	}
	
	if (document.forms[0].email.value == "")
	{
		alert("Please enter Email Address.");
		document.forms[0].email.focus();
		document.forms[0].email.select();
		return false;
	}
	
	if (document.forms[0].email.value.length > 0)
	{
		emailVal = document.forms[0].email.value;
		lastDotIndex = -1;
		atIndex = -1;
		
		
		for(i=0; i<emailVal.length; i++)
		{
			if(emailVal.charAt(i) == ".")
			{
				lastDotIndex = i;
			}
		}
		
		atIndex = emailVal.indexOf("@");
		
		
		if(atIndex == -1)
		{
			alert("Enter valid email address.");
			document.forms[0].email.focus();
			document.forms[0].email.select();
			return false;
		}
		if(lastDotIndex == -1)
		{
			alert("Enter valid email address");
			document.forms[0].email.focus();
			document.forms[0].email.select();
			return false;
		}
		if(lastDotIndex < atIndex)
		{
			alert("Enter valid email address.");
			document.forms[0].email.focus();
			document.forms[0].email.select();
			return false;
		}
	}
	
	if (document.forms[0].email_verify.value == "")
	{
		alert("Please enter Re-Type Email Address.");
		document.forms[0].email_verify.focus();
		document.forms[0].email_verify.select();
		return false;
	}	
	
	if (document.forms[0].email_verify.value != document.forms[0].email.value)
	{
		alert("Please enter same email address for Email Address and Re-Type Email Address.");
		document.forms[0].email.focus();
		document.forms[0].email.select();
		return false;
	}	
	
	var index = document.forms[0].type_appt.selectedIndex
	if (document.forms[0].type_appt.options[index].value == "")
	{
		alert("Please complete the Type of Appointment.");
		document.forms[0].type_appt.focus();
		return false;
	}
	if (document.forms[0].pcp_first_name.value == "")
	{
		alert("Please provide your Primary Care Physician's First Name");
		document.forms[0].pcp_first_name.focus();
		document.forms[0].pcp_first_name.select();
		return false;
	}
	if (document.forms[0].pcp_last_name.value == "")
	{
		alert("Please provide your Primary Care Physician's Last Name");
		document.forms[0].pcp_last_name.focus();
		document.forms[0].pcp_last_name.select();
		return false;
	}
	
	if (document.forms[0].pcp_phone1.value == "")
	{
		alert("Please provide your Primary Care Physician's Phone Number");
		document.forms[0].pcp_phone1.focus();
		document.forms[0].pcp_phone1.select();
		return false;
	}
	
	if (document.forms[0].symptoms.value == "")
	{
		alert("Please provide a Brief Description of Symptoms/Reason for Appointment");
		document.forms[0].symptoms.focus();
		document.forms[0].symptoms.select();
		return false;
	}
	if (document.forms[0].symptoms.value.length > 250)
	{
		alert("The text you entered for Symptoms/Reason exceeds the maximum limit of 250 charecters. Please modify your text.");
		document.forms[0].symptoms.focus();
		document.forms[0].symptoms.select();
		return false;
	}

}

function same()
{
	document.forms[0].contact_last_name.value = document.forms[0].pat_last_name.value;
	document.forms[0].contact_first_name.value = document.forms[0].pat_first_name.value;
	document.forms[0].contact_relationship.value = ' Patient (SELF)';
}
//-->