d=self.document;

d.write("<form method='post' action='forMail.php'><input type='hidden' name='recipients' value='hypnosishealingscenterOmanOmanhotmail.com'><input type='hidden' name='subject' value='Website Contact Form'><input type='hidden' name='mail_options' value='KeepLines'><input type='hidden' name='required' value='email:Your email,realname:Your name,message:Your message'><input type='hidden' name='good_url' value='http://arizona.hypnosishealingscenter.com/thanks.php'><input type='hidden' name='bad_url' value='http://arizona.hypnosishealingscenter.com/error.php'>");

d.write("<table cellspacing='0' cellpadding='0' border='0'><tr><td valign='top' style='padding-right: 10px;'><p style='margin-bottom: 0;'>Your Name:</p><input type='text' name='realname' size='29' style='background: #b0e0e6;'><p style='margin-bottom: 0;'>Your Email:</p><input type='text' name='email' size='29' style='background: #b0e0e6;'><br /><br /><p style='font: 11px arial, helvetica, sans-serif;'>Visit <a href='http://www.tectite.com/' target='_blank' title='www.tectite.com' style='font-weight: normal;'>www.tectite.com</a><br />for free FormMail software.</p></td><td><p style='margin-bottom: 0;'>Your Message:</p><textarea name='message' cols='33' rows='10' style='background: #b0e0e6;'></textarea><br /><input type='reset' value='Reset' name='reset' style='cursor: hand;'><input type='submit' value='Submit' name='submit' style='cursor: hand;'><br /><h4 style='margin: 0;'>Please press \"Submit\" only once!</h4></td></tr></table></form>");