ÿþ<html> <head> <meta http-equiv="Content-Type" content="text/html; charset=UTF-8"> <title>Prenotazione - Poliambulatorio Santa Rita Padova</title> <meta name="description" content="Prenota online o al numero 049.73.88.650"> <link href="../style.css" rel="stylesheet" type="text/css"> <script language="JavaScript" type="text/javascript" src="../pngfix.js"></script> <script src="../Scripts/AC_RunActiveContent.js" type="text/javascript"></script> <script type="text/javascript"> <!-- function MM_swapImgRestore() { //v3.0 var i,x,a=document.MM_sr; for(i=0;a&&i<a.length&&(x=a[i])&&x.oSrc;i++) x.src=x.oSrc; } function MM_preloadImages() { //v3.0 var d=document; if(d.images){ if(!d.MM_p) d.MM_p=new Array(); var i,j=d.MM_p.length,a=MM_preloadImages.arguments; for(i=0; i<a.length; i++) if (a[i].indexOf("#")!=0){ d.MM_p[j]=new Image; d.MM_p[j++].src=a[i];}} } function MM_findObj(n, d) { //v4.01 var p,i,x; if(!d) d=document; if((p=n.indexOf("?"))>0&&parent.frames.length) { d=parent.frames[n.substring(p+1)].document; n=n.substring(0,p);} if(!(x=d[n])&&d.all) x=d.all[n]; for (i=0;!x&&i<d.forms.length;i++) x=d.forms[i][n]; for(i=0;!x&&d.layers&&i<d.layers.length;i++) x=MM_findObj(n,d.layers[i].document); if(!x && d.getElementById) x=d.getElementById(n); return x; } function MM_swapImage() { //v3.0 var i,j=0,x,a=MM_swapImage.arguments; document.MM_sr=new Array; for(i=0;i<(a.length-2);i+=3) if ((x=MM_findObj(a[i]))!=null){document.MM_sr[j++]=x; if(!x.oSrc) x.oSrc=x.src; x.src=a[i+2];} } //--> </script> <style type="text/css"> <!-- #contenitore { position:relative; left:0px; top:0px; width:1px; height:1px; z-index:1; } #quadrato { position:absolute; left:500px; top:140px; width:389px; z-index:2; } #testi { position:absolute; left:300px; top:160px; width:570px; z-index:3; } --> </style> </head> <body onLoad="MM_preloadImages('../images/menu/poliambulatorio_up.png','../images/menu/medicina_specialistici_up.png','../images/menu/fisioterapia_up.png','../images/menu/dietologia_up.png','../images/menu/medicina_estetica_up.png','../images/menu/medicina_sportiva_up.png','../images/menu/contatti_up.png','../images/menu/dove_up.png','../images/menu/organigramma_up.png')"> <table width="930" border="0" align="center" cellpadding="0" cellspacing="0"> <tr> <td height="40" valign="top"><div id="contenitore"><div id="quadrato"> <table width="389" border="0" cellspacing="0" cellpadding="0"> <tr> <td height="20"><img src="../images/quadrato_01.png" width="389" height="20"></td> </tr> <tr> <td><img src="../images/quadrato_02.png" width="389" height="25"></td> </tr> <tr> <td><img src="../images/quadrato_03.png" width="389" height="392"></td> </tr> </table> </div><div id="testi"> <table width="570" border="0" cellpadding="0" cellspacing="10" class="txt"> <tr> <td><p><img src="../images/tit_prenotazione.png" width="350" height="30"></p> </td> </tr> <tr> <td><p>La prenotazione delle prestazioni sanitarie puo' essere effettuata:</p> <ul> <li>direttamente <span class="evidenzia">all'accettazione del Centro</span>, presso la sede di Via Pastore 6</li> <li><span class="evidenzia">telefonando</span> al numero 049.73.88.650</li> <li>compilando il <span class="evidenzia">seguente modulo</span></li> </ul> <p>In caso di impossibilità viene cortesemente richiesto ai gentili clienti di dare disdetta.</p></td> </tr> <tr> <td class="evidenzia"><hr size="1" noshade> MODULO RICHIESTA DISPONIBILITÀ PER PRENOTAZIONE</td> </tr> <tr> <td> <form method=POST action=prenotazione.php name=FRM> <table width="550" border="0" cellpadding="0" cellspacing="5" class="txtSmall"> <tr> <td width="200" valign="top"> Nome <br> <input name="UTEnom" type="text" id="textfield" size="25"> </td> <td width="200" valign="top"> Cognome <br> <input name="UTEcog" type="text" id="textfield2" size="25"> </td> <td width="150"></td> </tr> <tr> <td width="200" valign="top"> Telefono <br> <input name="UTEtel" type="text" id="textfield3" size="25"> </td> <td width="200" valign="top"> E-mail <br> <input name="UTEema" type="text" id="textfield3" size="25"> </td> <td width="150"></td> </tr> <tr> <td colspan="2" width="400" valign="top"> Prestazione richiesta <br> <input name="PREric" type="text" id="textfield4" size="60"> </td> <td width="150"></td> </tr> <tr> <td width="200" valign="top"> Giorno preferito <select name="GIOpre" id="select4"> <option value="qualsiasi" selected>qualsiasi </option> <option value="Lunedi" >lunedì </option> <option value="Martedi" >martedì </option> <option value="Mercoledi" >mercoledì </option> <option value="Giovedi" >giovedì </option> <option value="Venerdi" >venerdì </option> <option value="Sabato mattina" >sabato mattina</option> </select> <br> </td> <td valign="top"> Orario preferito <br> <select name="ORApre" id="select3"> <option value="mattino" selected>mattino </option> <option value="9.00-11.00" >9.00-11.00 </option> <option value="11.00-13.00" >11.00-13.00</option> <option value="pomeriggio" >pomeriggio </option> <option value="15.30-17.30" >15.30-17.30</option> <option value="17.30-20.00" >17.30-20.00</option> </select> </td> <td width="150" valign="bottom"> <input type="submit" name="button" id="button" value="Invia la richiesta"> </td> </tr> <tr> <td colspan="3" valign="top"><hr size="1" noshade></td> </tr> </table> </form> </td> </tr> </table> </div></div></td> <td>&nbsp;</td> </tr> <tr> <td width="300" valign="top"><table width="300" border="0" cellspacing="0" cellpadding="0"> <tr> <td><script type="text/javascript"> AC_FL_RunContent( 'codebase','http://download.macromedia.com/pub/shockwave/cabs/flash/swflash.cab#version=9,0,28,0','width','300','height','305','src','../poliambulatorio','quality','best','pluginspage','http://www.adobe.com/shockwave/download/download.cgi?P1_Prod_Version=ShockwaveFlash','wmode','transparent','movie','../poliambulatorio' ); //end AC code </script> <noscript> <object classid="clsid:D27CDB6E-AE6D-11cf-96B8-444553540000" codebase="http://download.macromedia.com/pub/shockwave/cabs/flash/swflash.cab#version=9,0,28,0" width="300" height="305"> <param name="movie" value="../poliambulatorio.swf"> <param name="quality" value="best"> <param name="wmode" value="transparent"> <embed src="../poliambulatorio.swf" width="300" height="305" quality="best" pluginspage="http://www.adobe.com/shockwave/download/download.cgi?P1_Prod_Version=ShockwaveFlash" type="application/x-shockwave-flash" wmode="transparent"></embed> </object> </noscript> </td> </tr> <tr> <td><table width="300" border="0" cellspacing="0" cellpadding="0"> <tr> <td width="100">&nbsp;</td> <td valign="top"><a href="../poliambulatorio/index.htm" onMouseOut="MM_swapImgRestore()" onMouseOver="MM_swapImage('Poliambulatorio','','../images/menu/poliambulatorio_up.png',1)"><img src="../images/menu/poliambulatorio.png" alt="Poliambulatorio" name="Poliambulatorio" width="145" height="17" border="0"></a></td> </tr> <tr> <td>&nbsp;</td> <td height="24" valign="top"><a href="../poliambulatorio/organigramma.htm" onMouseOut="MM_swapImgRestore()" onMouseOver="MM_swapImage('Organigramma','','../images/menu/organigramma_up.png',1)"><img src="../images/menu/organigramma.png" alt="Organigramma" name="Organigramma" width="145" height="17" border="0"></a></td> </tr> <tr> <td>&nbsp;</td> <td valign="top"><a href="../servizi_medici/index.htm" onMouseOut="MM_swapImgRestore()" onMouseOver="MM_swapImage('servizimedici','','../images/menu/medicina_specialistici_up.png',1)"><img src="../images/menu/medicina_specialistici.png" alt="Visite Mediche" name="servizimedici" width="145" height="17" border="0"></a></td> </tr> <tr> <td>&nbsp;</td> <td valign="top"><a href="../servizi_medici/fisioterapia.htm" onMouseOut="MM_swapImgRestore()" onMouseOver="MM_swapImage('Fisioterapia','','../images/menu/fisioterapia_up.png',1)"><img src="../images/menu/fisioterapia.png" alt="Fisioterapia" name="Fisioterapia" width="145" height="17" border="0"></a></td> </tr> <tr> <td>&nbsp;</td> <td valign="top"><a href="../servizi_medici/dietologia.htm" onMouseOut="MM_swapImgRestore()" onMouseOver="MM_swapImage('Dietologia','','../images/menu/dietologia_up.png',1)"><img src="../images/menu/dietologia.png" alt="Dietologia" name="Dietologia" width="145" height="17" border="0"></a></td> </tr> <tr> <td>&nbsp;</td> <td valign="top"><a href="../servizi_medici/medicina_estetica.htm" onMouseOut="MM_swapImgRestore()" onMouseOver="MM_swapImage('medicinaestetica','','../images/menu/medicina_estetica_up.png',1)"><img src="../images/menu/medicina_estetica.png" alt="Medicina Estetica" name="medicinaestetica" width="145" height="17" border="0"></a></td> </tr> <tr> <td>&nbsp;</td> <td height="24" valign="top"><a href="../servizi_medici/medicina_sportiva.htm" onMouseOut="MM_swapImgRestore()" onMouseOver="MM_swapImage('medicinasportiva','','../images/menu/medicina_sportiva_up.png',1)"><img src="../images/menu/medicina_sportiva.png" alt="Medicina Sportiva" name="medicinasportiva" width="145" height="17" border="0"></a></td> </tr> <tr> <td>&nbsp;</td> <td valign="top"><a href="../visite_specialistiche/index.htm" onMouseOut="MM_swapImgRestore()" onMouseOver="MM_swapImage('Contatti','','../images/menu/contatti_up.png',1)"><img src="../images/menu/contatti.png" alt="Contatti" name="Contatti" width="145" height="17" border="0"></a></td> </tr> <tr> <td>&nbsp;</td> <td valign="top"><a href="../visite_specialistiche/prenotazione.htm"><img src="../images/menu/prenotazione_up.png" alt="Prenotazione" name="Prenotazione" width="145" height="17" border="0"></a></td> </tr> <tr> <td>&nbsp;</td> <td valign="top"><a href="../visite_specialistiche/dove_siamo.htm" onMouseOut="MM_swapImgRestore()" onMouseOver="MM_swapImage('dovesiamo','','../images/menu/dove_up.png',1)"><img src="../images/menu/dove.png" alt="Dove Siamo" name="dovesiamo" width="145" height="17" border="0"></a></td> </tr> </table></td> </tr> </table> </td> <td>&nbsp;</td> </tr> </table> </body> </html>