
document.write('<form action="/services/findadoc/list.php" method="GET">Choose a specialty:<br /><select name="fmSpecialty" style="font-size:11px"><option value="" selected="selected">Any</option><option>Cardiology</option><option>Cardiothoracic Surgery</option><option>Pediatric Cardiology</option></select><br /><br />Choose a hospital:<br /><select name="fmAffil" style="font-size:11px"><option value="" selected="selected">Any</option><option value="RIH">Rhode Island Hospital</option><option value="HASBRO">Hasbro Children&#39;s Hospital</option><option value="TMH">Miriam Hospital</option><option value="NH">Newport Hospital</option></select><br /><br /><input type="submit" name="I3" value="Go!"> </p></form>'); 




