document.write("<link href=\"https://sxxzyyy.com/statics/css/dialog.css\" rel=\"stylesheet\" type=\"text/css\" /><script type=\"text/javascript\" src=\"https://sxxzyyy.com/statics/js/dialog.js\"></script>  <div class=\"list_list\"><h2 class=\"gh_h2\">在线留言</h2><p class=\"gh_p\">感谢您写下宝贵留言，濉溪县中医医院全心为您服务！</p><div class=\"form_gh\"><form method=\"post\" action=\"https://sxxzyyy.com/index.php?m=formguide&c=index&a=show&formid=14&siteid=1\" name=\"myform\" id=\"myform\"><ul><li>  <label > 姓名:</label>  <input type=\"text\" name=\"info[name]\" id=\"name\" size=\"50\" value=\"\"  class=\"input-text\"  >  </li><li>  <label > 电话:</label>  <input type=\"text\" name=\"info[iphone]\" id=\"iphone\" size=\"50\" value=\"\"  class=\"input-text\"  >  </li><li>  <label > 留言内容:</label>  <textarea name=\'info[liuyan]\' id=\'liuyan\' style=\'width:100%%;height:46px;\'   ></textarea>  </li><li style=\"overflow: hidden;\"><label style=\"text-align:left; float: left; \">验证码:</label><div class=\"fl\"><span title=\"点击更换验证码\" style=\" cursor:pointer;\"><input type=\"text\" id=\"code\" name=\"code\" size=\"8\" class=\"input-text\"><img id=\'code_img\' onclick=\'this.src=this.src+\"&\"+Math.random()\' src=\'https://sxxzyyy.com/api.php?op=checkcode&code_len=4&font_size=14&width=100&height=30&font_color=&background=\'></span></div></li>  </ul>  <input  class=\"tj_btn\" type=\"submit\" name=\"dosubmit\" id=\"dosubmit\" value=\" 提交 \"></form></div>          </div>");