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	<title>Pide cita en la Clínica OnBlood</title>
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<body>
<div class="titulo_menu">
	<h1 class="titulo_menu" style="text-align:center;">Contacta con nosotros</h1>
</div>

<script language="javascript" type="text/javascript">
	function val_contactar() {
		campo = new Array();
		tipo = new Array();
		obligado = new Array();
		longitud = new Array();
		etiqueta = new Array();
		i = 0;
		//TABLE_NAME='NBLContacto' AND COLUMN_NAME='Nombre'
					//Nombre:False
			campo[i] = "Nombre";
			tipo[i] = 1;
			obligado[i] = true;
			longitud[i] = 255;
			etiqueta[i++] = 'Nombre';
			//TABLE_NAME='NBLContacto' AND COLUMN_NAME='Email'
					//Email:False
			campo[i] = "Email";
			tipo[i] = 2;
			obligado[i] = false;
			longitud[i] = 255;
			etiqueta[i++] = 'Email';
			//TABLE_NAME='NBLContacto' AND COLUMN_NAME='Telefono'
					//Telefono:False
			campo[i] = "Telefono";
			tipo[i] = 1;
			obligado[i] = true;
			longitud[i] = 50;
			etiqueta[i++] = 'Telf.';
			//TABLE_NAME='NBLContacto' AND COLUMN_NAME='Ciudad'
					//Ciudad:False
			campo[i] = "Ciudad";
			tipo[i] = 1;
			obligado[i] = true;
			longitud[i] = 255;
			etiqueta[i++] = 'Ciudad';
			//TABLE_NAME='NBLContacto' AND COLUMN_NAME='DescribeContacto'
					//DescribeContacto:False
			campo[i] = "DescribeContacto";
			tipo[i] = 1;
			obligado[i] = true;
			longitud[i] = 65500;
			etiqueta[i++] = 'Escribe tu consulta';
			

	}
</script>
	
<form action="insertar_contacto.asp" method="post" name="contactar" id="contactar" enctype='multipart/form-data' class="contact-form" >
	<div class="formulario">
	<div class="bloque_linea">
				<div class="sep_bloque_linea">
			<div class="etiqueta fleft vertical etcampo200"><label class="lbNombre" for="Nombre">Nombre*</label></div>
			<div class="dato fleft vertical dtcampo200">
			
			<input class="ftcampo2" type="text" name="Nombre" id="Nombre" onkeypress="javascript: return cadena(event);" value=""   onfocus="javascript:this.select(); if(this.value=='') { this.value='';} void(0);" onblur="javascript:if(this.value=='') {this.value='';} void(0);"/>	</div>
			</div><!-- dato -->
	
		</div><!-- linea -->
	<div class="bloque_linea">
				<div class="sep_bloque_linea">
			<div class="etiqueta fleft vertical etcampo200"><label class="lbEmail" for="Email">Email</label></div>
			<div class="dato fleft vertical dtcampo200">
			
			<input class="ftcampo2" type="text" name="Email" id="Email" onkeypress="javascript: return email(event);" value=""   onfocus="javascript:this.select(); if(this.value=='') { this.value='';} void(0);" onblur="javascript:if(this.value=='') {this.value='';} void(0);"/>	</div>
			</div><!-- dato -->
	
		</div><!-- linea -->
	<div class="bloque_linea">
				<div class="sep_bloque_linea">
			<div class="etiqueta fleft vertical etcampo200"><label class="lbTelefono" for="Telefono">Telf.*</label></div>
			<div class="dato fleft vertical dtcampo200">
			
			<input class="ftcampo2" type="text" name="Telefono" id="Telefono" onkeypress="javascript: return numero(event);" value=""   onfocus="javascript:this.select(); if(this.value=='') { this.value='';} void(0);" onblur="javascript:if(this.value=='') {this.value='';} void(0);"/>	</div>
			</div><!-- dato -->
	
		</div><!-- linea -->
	<div class="bloque_linea">
				<div class="sep_bloque_linea">
			<div class="etiqueta fleft vertical etcampo200"><label class="lbCiudad" for="Ciudad">Ciudad*</label></div>
			<div class="dato fleft vertical dtcampo200">
			
			<input class="ftcampo2" type="text" name="Ciudad" id="Ciudad" onkeypress="javascript: return cadena(event);" value=""   onfocus="javascript:this.select(); if(this.value=='') { this.value='';} void(0);" onblur="javascript:if(this.value=='') {this.value='';} void(0);"/>	</div>
			</div><!-- dato -->
	
		</div><!-- linea -->
	<div class="bloque_linea2">
				<div class="sep_bloque_linea">
			<div class="etiqueta fleft vertical etcampo201"><label class="lbDescribeContacto" for="DescribeContacto">Escribe tu consulta*</label></div>
			<div class="dato fleft vertical dtcampo201">
			
			<textarea  class="ftacampo2" type="text" name="DescribeContacto" id="DescribeContacto" cols="40" rows="8" onfocus="javascript:this.select();" ></textarea>
				</div>
			</div><!-- dato -->
	
		</div><!-- linea -->
	
	<div class="lpd w100"><b class="negrita_editor">Campos obligatorios *</b>
<br>
<b class="negrita_editor">Al pulsar enviar acepto la <a class="rojo" style="text-decoration:underline;" href="http://onblood.es/politica_de_privacidad_y_aviso_legal.html">LOPD</a></b><input type=hidden name=IdNBLCentro value=></div>
	
	<div class="bloque_boton ">
		<div class="button fcolor">
	        <a class="lbutton" href="javascript: val_contactar(); validateOnSubmit('contactar'); void(0);">Enviar</a>
		</div>
	</div>
	
	<div class="oculto"><input type="hidden" name="FechaIns" value="21/05/2013 9:19:27" /></div>
</div> <!-- formulario -->
</form>

</body>
</html>
