document.write('\	\	\<FORM\ ACTION\=\"http\:\/\/www\.bizland\.com\/StoreSurveyResults\.mpl\"\ METHOD\=\"POST\"\ TARGET\=\'mywindow\'\ onSubmit\=\"window\.open\(\'about\:blank\'\,\'mywindow\'\,\ \'toolbar\=no\,location\=no\,directories\=no\,status\=no\,menubar\=no\,scrollbars\=yes\,resizable\=yes\,copyhistory\=no\,width\=400\,height\=400\'\)\"\ \>\	\<TABLE\ \ BGCOLOR\=\"\#ffffff\"\ CELLSPACING\=0\ CELLPADDING\=0\ border\=1\ bordercolor\=\"\#336699\"\ \>\	\<TR\>\<TD\>\	\<TABLE\ BGCOLOR\=\"\#ffffff\"\ CELLSPACING\=0\ CELLPADDING\=1\>\	\	\<TR\ BGCOLOR\=\"\#336699\"\>\	\	\	\<TD\ COLSPAN\=2\ ALIGN\=\"CENTER\"\>\	\	\	\	\<FONT\ FACE\=\"Verdana\"\ color\=white\ SIZE\=2\>\<B\>Survey\ \<\/font\>\<\/B\>\	\	\	\<\/TD\>\	\	\<\/TR\>\	\	\	\	\<TR\>\	\	\	\	\<TD\ VALIGN\=TOP\>\	\	\	\	\	\<B\>\<FONT\ FACE\=\"Verdana\"\ SIZE\=1\>1\&nbsp\;\ \<\/FONT\>\<\/B\>\	\	\	\	\<\/TD\>\	\	\	\	\<TD\ \>\	\	\	\	\	\<B\>\<FONT\ FACE\=\"Verdana\"\ SIZE\=1\>DO\ YOU\ KNOW\ HOW\ TO\ DO\ C\.P\.R\.\ \?\ \<\/FONT\>\<\/B\>\<BR\>\	\	\	\	\	\<FONT\ FACE\=\"Verdana\"\ SIZE\=2\>Yes\ \<\/FONT\>\<INPUT\ TYPE\=\"radio\"\ NAME\=\"control0\"\ VALUE\=\"Yes\"\>\	\	\	\	\	\<FONT\ FACE\=\"Verdana\"\ SIZE\=2\>No\ \<\/FONT\>\<INPUT\ TYPE\=\"radio\"\ NAME\=\"control0\"\ VALUE\=\"No\"\>\	\	\	\	\<\/TD\>\	\	\	\<\/TR\>\	\	\	\	\	\	\<TR\>\	\	\	\	\<TD\ VALIGN\=TOP\>\	\	\	\	\	\<B\>\<FONT\ FACE\=\"Verdana\"\ SIZE\=1\>2\&nbsp\;\ \<\/FONT\>\<\/B\>\	\	\	\	\<\/TD\>\	\	\	\	\<TD\ \>\	\	\	\	\	\<B\>\<FONT\ FACE\=\"Verdana\"\ SIZE\=1\>DO\ YOU\ KNOW\ THE\ SIGN\'S\ OF\ A\ HEART\ ATTACK\-OR\-STROKE\ \?\ \<\/FONT\>\<\/B\>\<BR\>\	\	\	\	\	\<FONT\ FACE\=\"Verdana\"\ SIZE\=2\>Yes\ \<\/FONT\>\<INPUT\ TYPE\=\"radio\"\ NAME\=\"control1\"\ VALUE\=\"Yes\"\>\	\	\	\	\	\<FONT\ FACE\=\"Verdana\"\ SIZE\=2\>No\ \<\/FONT\>\<INPUT\ TYPE\=\"radio\"\ NAME\=\"control1\"\ VALUE\=\"No\"\>\	\	\	\	\<\/TD\>\	\	\	\<\/TR\>\	\	\	\	\	\	\<TR\>\	\	\	\	\<TD\ VALIGN\=TOP\>\	\	\	\	\	\<B\>\<FONT\ FACE\=\"Verdana\"\ SIZE\=1\>3\&nbsp\;\ \<\/FONT\>\<\/B\>\	\	\	\	\<\/TD\>\	\	\	\	\<TD\ \>\	\	\	\	\	\<B\>\<FONT\ FACE\=\"Verdana\"\ SIZE\=1\>DO\ YOU\ KNOW\ THE\ DEFINITION\ OF\ CONGESTIVE\ HEART\ FAILURE\ \?\ \<\/FONT\>\<\/B\>\<BR\>\	\	\	\	\	\<FONT\ FACE\=\"Verdana\"\ SIZE\=2\>Yes\ \<\/FONT\>\<INPUT\ TYPE\=\"radio\"\ NAME\=\"control2\"\ VALUE\=\"Yes\"\>\	\	\	\	\	\<FONT\ FACE\=\"Verdana\"\ SIZE\=2\>No\ \<\/FONT\>\<INPUT\ TYPE\=\"radio\"\ NAME\=\"control2\"\ VALUE\=\"No\"\>\	\	\	\	\<\/TD\>\	\	\	\<\/TR\>\	\	\	\	\	\	\<TR\>\	\	\	\	\<TD\ VALIGN\=TOP\>\	\	\	\	\	\<B\>\<FONT\ FACE\=\"Verdana\"\ SIZE\=1\>4\&nbsp\;\ \<\/FONT\>\<\/B\>\	\	\	\	\<\/TD\>\	\	\	\	\<TD\ \>\	\	\	\	\	\<B\>\<FONT\ FACE\=\"Verdana\"\ SIZE\=1\>DO\ YOU\ KNOW\ HOW\ TO\ LOWER\ YOUR\ \ RISK\ OF\ PREVENTING\ HEART\ DISEASE\ \?\ \<\/FONT\>\<\/B\>\<BR\>\	\	\	\	\	\<FONT\ FACE\=\"Verdana\"\ SIZE\=2\>Yes\ \<\/FONT\>\<INPUT\ TYPE\=\"radio\"\ NAME\=\"control3\"\ VALUE\=\"Yes\"\>\	\	\	\	\	\<FONT\ FACE\=\"Verdana\"\ SIZE\=2\>No\ \<\/FONT\>\<INPUT\ TYPE\=\"radio\"\ NAME\=\"control3\"\ VALUE\=\"No\"\>\	\	\	\	\<\/TD\>\	\	\	\<\/TR\>\	\	\	\	\	\	\<TR\>\	\	\	\	\<TD\ VALIGN\=TOP\>\	\	\	\	\	\<B\>\<FONT\ FACE\=\"Verdana\"\ SIZE\=1\>5\&nbsp\;\ \<\/FONT\>\<\/B\>\	\	\	\	\<\/TD\>\	\	\	\	\<TD\ \>\	\	\	\	\	\<B\>\<FONT\ FACE\=\"Verdana\"\ SIZE\=1\>DO\ YOU\ HAVE\ REGULAR\ CHECK\-UP\'S\ \?\ \<\/FONT\>\<\/B\>\<BR\>\	\	\	\	\	\<FONT\ FACE\=\"Verdana\"\ SIZE\=2\>Yes\ \<\/FONT\>\<INPUT\ TYPE\=\"radio\"\ NAME\=\"control4\"\ VALUE\=\"Yes\"\>\	\	\	\	\	\<FONT\ FACE\=\"Verdana\"\ SIZE\=2\>No\ \<\/FONT\>\<INPUT\ TYPE\=\"radio\"\ NAME\=\"control4\"\ VALUE\=\"No\"\>\	\	\	\	\<\/TD\>\	\	\	\<\/TR\>\	\	\	\	\	\	\<TR\>\	\	\	\	\<TD\ VALIGN\=TOP\>\	\	\	\	\	\<B\>\<FONT\ FACE\=\"Verdana\"\ SIZE\=1\>6\&nbsp\;\ \<\/FONT\>\<\/B\>\	\	\	\	\<\/TD\>\	\	\	\	\<TD\ \>\	\	\	\	\	\<B\>\<FONT\ FACE\=\"Verdana\"\ SIZE\=1\>DO\ YOU\ KNOW\ WHAT\ C\.O\.P\.D\.\ IS\ \?\ \ \<\/FONT\>\<\/B\>\<BR\>\	\	\	\	\	\<FONT\ FACE\=\"Verdana\"\ SIZE\=2\>Yes\ \<\/FONT\>\<INPUT\ TYPE\=\"radio\"\ NAME\=\"control5\"\ VALUE\=\"Yes\"\>\	\	\	\	\	\<FONT\ FACE\=\"Verdana\"\ SIZE\=2\>No\ \<\/FONT\>\<INPUT\ TYPE\=\"radio\"\ NAME\=\"control5\"\ VALUE\=\"No\"\>\	\	\	\	\<\/TD\>\	\	\	\<\/TR\>\	\	\	\	\<TR\>\	\	\<TD\ COLSPAN\=2\ BGCOLOR\=\"ffffff\"\ ALIGN\=\"CENTER\"\ \>\	\	\	\<INPUT\ TYPE\=\"submit\"\ NAME\=\"SendtoFile\"\ VALUE\=\"Submit\"\ \>\	\	\	\<INPUT\ TYPE\=\"reset\"\ NAME\=\"reset\"\ VALUE\=\"Clear\"\>\	\	\<\/TD\>\	\<\/TR\>\	\<INPUT\ TYPE\=\"hidden\"\ NAME\=\"pollname\"\ VALUE\=\"ARE\"\>\	\<INPUT\ TYPE\=\"hidden\"\ NAME\=\"username\"\ VALUE\=\"carolsplayground\"\>\	\<INPUT\ TYPE\=\"hidden\"\ NAME\=\"noofQuestions\"\ VALUE\=\"6\"\>\	\<INPUT\ TYPE\=\"hidden\"\ NAME\=\"YNview\"\ VALUE\=\"Yes\"\>\	\<\/TABLE\>\	\<\/TD\>\<\/TR\>\<\/TABLE\>\	\<\/FORM\>\	\	\	');