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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;">Pide Cita</h1>
</div>
<span style="display: block; text-align: center; color: #BE3A2E; font-size: 16px; font-weight: bold;padding: 0px 20px 20px 20px;">Centro Médico Mediterráneo- CEMM</span>

<script>
	function validaEmail(valor) {
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            alert("La dirección de email es incorrecta.");
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    }
    
    function val_contactar(){
        var retorno = true;
        if(retorno){
            if($('#Nombre').val()==""){
                alert("El campo Nombre es obligatorio");
                $('#Nombre').focus();
                retorno = false;
            }
        }
        if(retorno){
            if($('#Apellidos').val()==""){
                alert("El campo Apellidos es obligatorio");
                $('#Apellidos').focus();
                retorno = false;
            }
        }
        if(retorno){
            if($('#Email').val()==""){
                alert("El campo Email es obligatorio");
                $('#Email').focus();
                retorno = false;
            } else {
		if(validaEmail($("#Email").val())){
		    retorno = true;
		} else {
		    retorno = false;
		    $("#Email").focus();
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	    }
        }
        if(retorno){
            if($('#Telefono').val()==""){
                alert("El campo Telefono es obligatorio");
                $('#Telefono').focus();
                retorno = false;
            }
        }
        if(retorno){
            if($('#DescribeLesion').val()==""){
                alert("Indicanos cual es tu lesión.");
                $('#DescribeLesion').focus();
                retorno = false;
            }
        }
        if(retorno){
            if($('#AceptoLOPD').is(":checked")){
            } else {
                alert("Tienes que aceptar la política de privacidad.");
                retorno = false;
            }
        }
        if(retorno){
            $('#contactar').attr("action","http://tulesion.com/insertar_cita_onblood.php");
            $('#contactar').submit();
        }
    }
</script>    
<form class="contact-form" enctype="multipart/form-data" id="contactar" name="contactar" method="post">
    <div class="formulario">
        <div class="bloque_linea">
            <div class="sep_bloque_linea">
                <div class="etiqueta fleft vertical etcampo200"><label for="Nombre" class="lbNombre">Nombre*</label></div>
                <div class="dato fleft vertical dtcampo200">
                <input type="text" onblur="javascript:if(this.value=='') {this.value='';} void(0);" onfocus="javascript:this.select(); if(this.value=='') { this.value='';} void(0);" value="" onkeypress="javascript: return cadena(event);" id="Nombre" name="Nombre" class="ftcampo2" />	</div>
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        <div class="bloque_linea">
            <div class="sep_bloque_linea">
                <div class="etiqueta fleft vertical etcampo200"><label for="Apellidos" class="lbCiudad">Apellidos*</label></div>
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        </div><!-- linea -->
        
        <div class="bloque_linea">
            <div class="sep_bloque_linea">
                <div class="etiqueta fleft vertical etcampo200"><label for="Email" class="lbEmail">Email*</label></div>
                <div class="dato fleft vertical dtcampo200">
                <input type="text" onblur="javascript:if(this.value=='') {this.value='';} void(0);" onfocus="javascript:this.select(); if(this.value=='') { this.value='';} void(0);" value="" onkeypress="javascript: return email(event);" id="Email" name="Email" class="ftcampo2" />	</div>
            </div><!-- dato -->
        </div><!-- linea -->
        
        <div class="bloque_linea">
            <div class="sep_bloque_linea">
                <div class="etiqueta fleft vertical etcampo200"><label for="Telefono" class="lbTelefono">Telf.*</label></div>
                <div class="dato fleft vertical dtcampo200">
                <input type="text" onblur="javascript:if(this.value=='') {this.value='';} void(0);" onfocus="javascript:this.select(); if(this.value=='') { this.value='';} void(0);" value="" onkeypress="javascript: return numero(event);" id="Telefono" name="Telefono" class="ftcampo2" />	</div>
            </div><!-- dato -->
        </div><!-- linea -->

        <div class="bloque_linea2">
            <div class="sep_bloque_linea">
                <div class="etiqueta fleft vertical etcampo201"><label for="DescribeLesion" class="lbDescribeLesion">Describe tu lesión*</label></div>
                <div class="dato fleft vertical dtcampo201">
                    <textarea onfocus="javascript:this.select();" rows="8" cols="40" id="DescribeLesion" name="DescribeLesion" class="ftacampo2"></textarea>
                </div>
            </div><!-- dato -->
        </div><!-- linea -->
        
        <div class="bloque_linea">
            <div class="sep_bloque_linea">
                <div class="etiqueta fleft vertical etcampo16"><label for="AceptoLOPD" class="lbAceptoLOPD">Acepto la <a target="blank" alt="Política Legal y LOPD" href="http://onblood.es/politica_de_privacidad_y_aviso_legal.html" <a="" style="text-decoration:underline;" class="rojo">LOPD</a>*</label></div>
                <div class="dato fleft vertical dtcampo16">
                    <script type="text/javascript" language="javascript">
                        function chequear(este) {
                            if(este.value==1) { 
                                este.value=""; 
                            } else  {
                                este.value=1;
                            }
                        }
                    </script>
                    <input type="checkbox" value="1" onclick="javascript: chequear(this); void(0); " checked="checked" id="AceptoLOPD" name="AceptoLOPD" class="frcampo">
                </div>
            </div><!-- dato -->
        </div><!-- linea -->
        
        <div class="lpd w100"><b class="negrita_editor">* Campos obligatorios</b>
        <br/>
        <br/>
        
        <b style="color:#BE3A2E;">En un plazo máximo de 24 horas (días laborables) nos pondremos en contacto contigo para confirmarte la cita con el centro.</b> 
        <br/>
        <br/>
        <input type="hidden" value="20" name="IdNBLCentro" /></div>
        
        <div class="bloque_boton ">
        <div class="button fcolor">
        <a href="javascript: val_contactar(); void(0);" class="lbutton">Enviar</a>
        </div>
        </div>
        
        <div class="oculto"><input type="hidden" value="09/07/2012 9:58:40" name="FechaIns" /></div>
    </div> <!-- formulario -->
</form>


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