// JavaScript Document
function valid_required(field)
{
         if(field=="")          {
         return false;
         }
    return true;
}


function echeck(str) {

		var at="@"
		var dot="."
		var lat=str.indexOf(at)
		var lstr=str.length
		var ldot=str.indexOf(dot)
		if (str.indexOf(at)==-1){
		   alert("Invalid E-mail ID")
		   return false
		}
		if (str.indexOf(at)==-1 || str.indexOf(at)==0 || str.indexOf(at)==lstr){
		   alert("Invalid E-mail ID")
		   return false
		}

		if (str.indexOf(dot)==-1 || str.indexOf(dot)==0 || str.indexOf(dot)==lstr){
		    alert("Invalid E-mail ID")
		    return false
		}

		 if (str.indexOf(at,(lat+1))!=-1){
		    alert("Invalid E-mail ID")
		    return false
		 }

		 if (str.substring(lat-1,lat)==dot || str.substring(lat+1,lat+2)==dot){
		    alert("Invalid E-mail ID")
		    return false
		 }

		 if (str.indexOf(dot,(lat+2))==-1){
		    alert("Invalid E-mail ID")
		    return false
		 }
		
		 if (str.indexOf(" ")!=-1){
		    alert("Invalid E-mail ID")
		    return false
		 }

 		 return true					
	}
	
function valForm()
{
		
		
        if(!valid_required(document.myform.fname.value) || document.myform.fname.value=="")
        {
			alert("Please enter First Name.")
			document.myform.fname.focus();
			return false;
        }
		
		if(!valid_required(document.myform.lname.value) || document.myform.lname.value=="")
        {
			alert("Please enter Last Name.")
			document.myform.lname.focus();
			return false;
        }
				
		if(!echeck(document.myform.email.value)){
			document.myform.email.focus();
			return false;
			
		}
		
		 if(!valid_required(document.myform.phone.value) || document.myform.phone.value=="")
        {
			alert("Please enter Phone.")
			document.myform.phone.focus();
			return false;
		 }
		 
		 		
		
    return true;
}


function valForm2()
{
		
		 
		  if(!valid_required(document.myform2.Name.value) || document.myform2.Name.value=="")
        {
			alert("Please enter Name.")
			document.myform2.Name.focus();
			return false;
		 }
		 
		 
		  if(!valid_required(document.myform2.Country.value) || document.myform2.Country.value=="None Selected")
        {
			alert("Please select Country.")
			document.myform2.Country.focus();
			return false;
		 }
		 
		 if(!echeck(document.myform2.Email.value)){
			document.myform2.Email.focus();
			return false;
			
		}
		
		
		
    return true;
}


function valForm3()
{
		
		 
		  if(!valid_required(document.myform2.firstname.value) || document.myform2.firstname.value=="")
        {
			alert("Please enter First Name.")
			document.myform2.firstname.focus();
			return false;
		 }
		 
		  if(!valid_required(document.myform2.lname.value) || document.myform2.lname.value=="")
        {
			alert("Please enter Last Name.")
			document.myform2.lname.focus();
			return false;
		 }
		 		 
		 
		
		
		 if(!valid_required(document.myform2.Phone.value) || document.myform2.Phone.value=="")
        {
			alert("Please enter Phone.")
			document.myform2.Phone.focus();
			return false;
		 }
		
		
		 if(!echeck(document.myform2.emailadd.value)){
			document.myform2.emailadd.focus();
			return false;
			
		}
		
		 
		  if(!valid_required(document.myform2.address.value) || document.myform2.address.value=="")
        {
			alert("Please enter Address.")
			document.myform2.address.focus();
			return false;
		 }
		 
		  if(!valid_required(document.myform2.city.value) || document.myform2.city.value=="")
        {
			alert("Please enter City.")
			document.myform2.city.focus();
			return false;
		 }
		
		 if(!valid_required(document.myform2.state.value) || document.myform2.state.value=="")
        {
			alert("Please enter State.")
			document.myform2.state.focus();
			return false;
		 }
		 
		  if(!valid_required(document.myform2.zip.value) || document.myform2.zip.value=="")
        {
			alert("Please enter Zip.")
			document.myform2.zip.focus();
			return false;
		 }
		
		 if(!valid_required(document.myform2.birth.value) || document.myform2.birth.value=="")
        {
			alert("Please enter Birth.")
			document.myform2.birth.focus();
			return false;
		 }
		 
		  if (!document.myform2.sex[0].checked && !document.myform2.sex[1].checked )
        {
            alert("Please select your Gender")
            document.myform2.sex[0].focus();
            return false;
        }     
		
		 if(!valid_required(document.myform2.physician.value) || document.myform2.physician.value=="")
        {
			alert("Please enter Physician Name.")
			document.myform2.physician.focus();
			return false;
		 }
		 
		  if(!valid_required(document.myform2.hear.value) || document.myform2.hear.value=="None Selected")
        {
			alert("Please enter How did you hear about Daavlin.")
			document.myform2.hear.focus();
			return false;
		 }
		 
		  if(!valid_required(document.myform2.skin.value) || document.myform2.skin.value=="None Selected")
        {
			alert("Please enter Skin Condition.")
			document.myform2.skin.focus();
			return false;
		 }
		 
		  if(document.myform2.skin.value=="Other" && document.myform2.skinother.value=="")
		  {
			  alert("Please specify Skin Condition.")
			document.myform2.skinother.focus();
			return false;
		  }
		 
		 
		  if(!valid_required(document.myform2.model.value) || document.myform2.model.value=="None Selected")
        {
			alert("Please enter Model and Lamp Quantity.")
			document.myform2.model.focus();
			return false;
		 }
		 
		  if(!valid_required(document.myform2.lamp.value) || document.myform2.lamp.value=="None Selected")
        {
			alert("Please enter Lamp Type.")
			document.myform2.lamp.focus();
			return false;
		 }
		 
		  if(document.myform2.lamp.value=="Other" && document.myform2.lampother.value=="")
		  {
			  alert("Please specify Lamp Type.")
			document.myform2.lampother.focus();
			return false;
		  }
		 
		 if(!valid_required(document.myform2.control.value) || document.myform2.control.value=="None Selected")
        {
			alert("Please enter Control System.")
			document.myform2.control.focus();
			return false;
		 }
		 
		 
		 
		 
		 
		 if(!valid_required(document.myform2.ordername.value) || document.myform2.ordername.value=="")
        {
			alert("Please enter Name on Order Confirmation.")
			document.myform2.ordername.focus();
			return false;
		 }
if(!valid_required(document.myform2.orderdate.value) || document.myform2.orderdate.value=="")
        {
			alert("Please enter Date on Order Confirmation.")
			document.myform2.orderdate.focus();
			return false;
		 }
if(!valid_required(document.myform2.primename.value) || document.myform2.primename.value=="")
        {
			alert("Please enter Name of Policy Holder.")
			document.myform2.primename.focus();
			return false;
		 }
if(!document.myform2.primesame.checked && document.myform2.primeaddress.value=="")
        {
			alert("Please enter Policy Holder's Address.")
			document.myform2.primeaddress.focus();
			return false;
		 }
		 
if(!valid_required(document.myform2.primephone.value) || document.myform2.primephone.value=="")
        {
			alert("Please enter Policy Holder's Phone.")
			document.myform2.primephone.focus();
			return false;
		 }
		 
		  if(!valid_required(document.myform2.primerel.value) || document.myform2.primerel.value=="None Selected")
        {
			alert("Please enter Relationship to Patient.")
			document.myform2.primerel.focus();
			return false;
		 }
		 
if(!valid_required(document.myform2.primebirth.value) || document.myform2.primebirth.value=="")
        {
			alert("Please enter Policy Holder's Birth.")
			document.myform2.primebirth.focus();
			return false;
		 }
if(!valid_required(document.myform2.primeschool.value) || document.myform2.primeschool.value=="")
        {
			alert("Please enter Employer/School Name.")
			document.myform2.primeschool.focus();
			return false;
		 }
if(!valid_required(document.myform2.primeid.value) || document.myform2.primeid.value=="")
        {
			alert("Please enter Insurance ID Number.")
			document.myform2.primeid.focus();
			return false;
		 }
if(!valid_required(document.myform2.primeplan.value) || document.myform2.primeplan.value=="")
        {
			alert("Please enter Insurance Group/Plan Number.")
			document.myform2.primeplan.focus();
			return false;
		 }
if(!valid_required(document.myform2.primecomp.value) || document.myform2.primecomp.value=="")
        {
			alert("Please enter Insurance Company.")
			document.myform2.primecomp.focus();
			return false;
		 }
if(!valid_required(document.myform2.primecompadd.value) || document.myform2.primecompadd.value=="")
        {
			alert("Please enter Insurance Company Address.")
			document.myform2.primecompadd.focus();
			return false;
		 }
if(!valid_required(document.myform2.primecompphone.value) || document.myform2.primecompphone.value=="")
        {
			alert("Please enter Insurance Company Phone Number.")
			document.myform2.primecompphone.focus();
			return false;
		 }
		 
		
		
		if (!document.myform2.hippa.checked)
        {
            alert("You must confirm that you have read Daavlin's HIPPA Privacy Policy")
            document.myform2.hippa.focus();
            return false;
        }    
		
		
		if (!document.myform2.bill.checked)
        {
            alert("You must confirm that you have read Daavlin's Patient Responsibilities and Patient Bill of Rights Policy")
            document.myform2.bill.focus();
            return false;
        }   
		if (!document.myform2.terms.checked)
        {
            alert("You must confirm that you have read and accept the Terms and Conditions of Sale Agreement ")
            document.myform2.terms.focus();
            return false;
        }   
		if (!document.myform2.benefits.checked)
        {
            alert("You mus confirm that you authorize Daavlin to acquire medical benefits for Durable Medical Equipment on your behalf")
            document.myform2.benefits.focus();
            return false;
        }   
		 
    return true;
}




function enableField()
{
if(document.myform2.skin.value=="Other")
		  
		  {
			 document.myform2.skinother.disabled=false;
		 }
		 else {
			
			 document.myform2.skinother.disabled=true;
			document.myform2.skinother.value="";
		 }
		 
if(document.myform2.lamp.value=="Other")
		  
		  {
			 document.myform2.lampother.disabled=false;
		 }
		 else {
			
			 document.myform2.lampother.disabled=true;
			document.myform2.lampother.value="";
		 }

if(document.myform2.primesame.checked)
		  
		  {
			 document.myform2.primeaddress.disabled=true;
			document.myform2.primeaddress.value="";
		 }
		 else {
			document.myform2.primeaddress.disabled=false;
			 
		 }


}