1 <!-- Form generated from formsWiz
-->
3 include_once("../../globals.php");
4 include_once("$srcdir/api.inc");
5 formHeader("Form: contacts");
8 <?php
html_header_show();?
>
9 <link rel
=stylesheet href
="<?php echo $css_header;?>" type
="text/css">
11 <body
<?php
echo $top_bg_line;?
> topmargin
=0 rightmargin
=0 leftmargin
=2 bottommargin
=0 marginwidth
=2 marginheight
=0>
12 <form method
=post action
="<?php echo $rootdir;?>/forms/contacts/save.php?mode=new" name
="my_form">
13 <span
class="title">Contacts
</span
><br
><br
>
18 <tr
><td
><span
class=text
>OD Base Curve
: </span
></td
><td
><input size
=4 type
=entry name
="od_base_curve" value
="" ></td
></tr
>
19 <tr
><td
><span
class=text
>OD Sphere
: </span
></td
><td
><input size
=4 type
=entry name
="od_sphere" value
="" ></td
></tr
>
20 <tr
><td
><span
class=text
>OD Cylinder
: </span
></td
><td
><input size
=4 type
=entry name
="od_cylinder" value
="" ></td
></tr
>
21 <tr
><td
><span
class=text
>OD Axis
: </span
></td
><td
><input size
=4 type
=entry name
="od_axis" value
="" ></td
></tr
>
22 <tr
><td
><span
class=text
>OD Diameter
: </span
></td
><td
><input size
=4 type
=entry name
="od_diameter" value
="" ></td
></tr
>
27 <tr
><td
><span
class=text
>OS Base Curve
: </span
></td
><td
><input size
=4 type
=entry name
="os_base_curve" value
="" ></td
></tr
>
28 <tr
><td
><span
class=text
>OS Sphere
: </span
></td
><td
><input size
=4 type
=entry name
="os_sphere" value
="" ></td
></tr
>
29 <tr
><td
><span
class=text
>OS Cylinder
: </span
></td
><td
><input size
=4 type
=entry name
="os_cylinder" value
="" ></td
></tr
>
30 <tr
><td
><span
class=text
>OS Axis
: </span
></td
><td
><input size
=4 type
=entry name
="os_axis" value
="" ></td
></tr
>
31 <tr
><td
><span
class=text
>OS Diameter
: </span
></td
><td
><input size
=4 type
=entry name
="os_diameter" value
="" ></td
></tr
>
38 <tr
><td
><span
class=text
>Material
: </span
></td
><td
><input size
=4 type
=entry name
="material" value
="" ></td
>
39 <td
><span
class=text
>Color
: </span
></td
><td
><input size
=4 type
=entry name
="color" value
="" ></td
>
40 <td
><span
class=text
>Bifocal Type
: </span
></td
><td
><input size
=4 type
=entry name
="bifocal_type" value
="" ></td
>
41 <td
><span
class=text
>Add
: </span
></td
><td
><input size
=4 type
=entry name
="add_value" value
="" ></td
>
42 <td
><span
class=text
>V
/A Far
: </span
></td
><td
><input size
=4 type
=entry name
="va_far" value
="" ></td
>
43 <td
><span
class=text
>V
/A Near
: </span
></td
><td
><input size
=4 type
=entry name
="va_near" value
="" ></td
>
50 <span
class=text
>Additional Notes
: </span
><br
><textarea cols
=40 rows
=8 wrap
=virtual name
="additional_notes" ></textarea
><br
>
55 <a href
="javascript:top.restoreSession();document.my_form.submit();" class="link_submit">[Save
]</a
>
57 <a href
="<?php echo $GLOBALS['form_exit_url']; ?>" class="link"
58 onclick
="top.restoreSession()">[Don
't Save]</a>