// JavaScript Document

function SubmitForma() {
	
	var sMsg = '';

	// check for incomplete fields
	


	if(IsEmpty(document.frmForma.first.value) == true){
		sMsg = sMsg + 'Please enter your First Name\n'
	};
	
	if(IsEmpty(document.frmForma.last.value) == true){
		sMsg = sMsg + 'Please enter your Last Name\n'
	};
	
	
	if(IsEmpty(document.frmForma.Email.value) == true){
		sMsg = sMsg + 'Please enter your Email\n'
	};
	
	
	if(IsEmpty(document.frmForma.phone1.value) == true || IsEmpty(document.frmForma.phone2.value) == true || IsEmpty(document.frmForma.phone3.value) == true){
		sMsg = sMsg + 'Please enter your Phone Number\n'
	};
		
	if(IsEmpty(document.frmForma.state.value) == true){
		sMsg = sMsg + 'Please select your State\n'
	};
	
	
	if(IsEmpty(document.frmForma.insurance.value) == true){
		sMsg = sMsg + 'Please select your primary insurance provider\n'
	};
	
	

	if(IsEmpty(document.frmForma.besttime.value) == true){
		sMsg = sMsg + 'What is the best time for us to reach you?\n'
	};

	// if any of the fields are incomplete
	if(sMsg !== '')	{
		sMsg = 'Please complete the following form values:\n\n'	+ sMsg;
		alert(sMsg);
		return false; // do not sumbit the form
	}
	
	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();
		
}