// JavaScript Document
// iFormType 0 = Short Form
//           1 = Long form
// iLanguage 0 = English
//           1 = Spanish
function SubmitForma(iFormType, iLanguage) {
	var sMsg = '';

	// fields required for all forms
	
	if(IsEmpty(document.frmForma.phone1.value) == true || IsEmpty(document.frmForma.phone2.value) == true || IsEmpty(document.frmForma.phone3.value) == true){
		if (iLanguage == 0 ) {
		   sMsg = sMsg + 'Please enter your Phone Number\n'
		} else {
		   sMsg = sMsg + 'Por favor entre su numero de teléfono\n'
		}
    };
	
	if(IsEmpty(document.frmForma.state.value) == true){
		if (iLanguage == 0 ) {
		   sMsg = sMsg + 'Please select your State\n'
		} else {
		   sMsg = sMsg + 'Por favor Entre su estado\n'
		}
	};
	
	
	// fields required for long form
	if (iFormType > 0) {
	   if(IsEmpty(document.frmForma.first_name.value) == true){
		   if (iLanguage == 0 ) {
		     sMsg = sMsg + 'Please enter your First Name\n'
		   } else {
		     sMsg = sMsg + 'Por favor entre su Nombre\n'
		   }
	   };
	
	   if(IsEmpty(document.frmForma.last_name.value) == true){
		   if (iLanguage == 0 ) {
		     sMsg = sMsg + 'Please enter your Last Name\n'
		   } else {
		     sMsg = sMsg + 'Por favor entre su apellido\n'
		   }
	   };
		
	   if(IsEmpty(document.frmForma.address.value) == true){
		   if (iLanguage == 0 ) {
		      sMsg = sMsg + 'Please enter your Address\n'
		   } else {
		      sMsg = sMsg + 'Por favor entre su dirección\n'
		   }
  	   };
	
	   if(IsEmpty(document.frmForma.city.value) == true){
		   if (iLanguage == 0 ) {
		      sMsg = sMsg + 'Please enter your City\n'
		   } else {
		      sMsg = sMsg + 'Por favor entre su ciudad\n'
		   }
	   };

	   if(IsEmpty(document.frmForma.postal_code.value) == true){
		   if (iLanguage == 0 ) {
		      sMsg = sMsg + 'Please select your Zip\n'
		   } else {
		      sMsg = sMsg + 'Por favor entre su código postal\n'
		   }
	   };
	
	   if(IsEmpty(document.frmForma.email.value) == true){
		   if (iLanguage == 0 ) {
		      sMsg = sMsg + 'Please enter your Email\n'
		   } else {
		      sMsg = sMsg + 'Por favor entre su correo electrónico\n'
		   }
	   };
	   
	   if(getInsurance().length <= 0) {
		   if (iLanguage == 0 ) {
	          sMsg  = sMsg + "Please select Are you on Medicare Y/N\n";
		   } else {
	          sMsg  = sMsg + "Tiene usted Medicare? Seleccione SI o NO\n";
		   }
	   }
	
// account for anytime option??
//	   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 !== '')	{
		if (iLanguage == 0 ) {
		   sMsg = 'Please complete the following form values:\n\n'	+ sMsg;
		} else {
		   sMsg = 'Por favor complete la siguiente información:\n\n' + sMsg;
		}
		
		alert(sMsg);
		return false; // do not sumbit the form
	}
	
//	if(document.getElementById('insurance').value == 'Y')
	if(getInsurance() == '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();
		
}

function getInsurance() {
   var sOutput;
   sOutput = "";
   for ( i=0; i < document.frmForma.insurance.length; i++ ) {
      if ( document.frmForma.insurance[i].checked ) {
         sOutput = document.frmForma.insurance[i].value;
      }
   }
   return(sOutput);
}