A Feedback Form - JxPharmacy - Doc JavaScript

A Feedback Form (Code)

This script (and relevant HTML code) creates a feedback form. The user can take advantage of the form to send you feedback or comments. The script verifies the user's e-mail address. Use this demonstration form to send me your feedback on Doc JavaScript.

Your e-mail address:

Subject:

Comments:

<br/><input type="submit" value="Send Mail" placeholder="disabled" disabled="disabled" title="form boxes are disabled in cached version of the site" value="Disabled" style="opacity:0.3;" /></form>
 
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</p><p><small>Created: November 6, 1997<br/>Revised: December 4, 1997<br/>URL: https://www.webreference.com/js/pharmacy/form.html</small></p>
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		<option value="compapplications">Computer Applications</option>
		<option value="comeng">Computer Engineering</option>
		<option value="comscience">Computer Science</option>
		<option value="cnp" selected="selected">Computer Prog. - Software Dev.</option>
		<option value="gameprogramming">Computer Game Programming</option>
		<option value="webdesign">Web Design</option>
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		<option value="internetsystems">Internet Systems</option>
        <option value="internetcertification">Internet Certification</option>
        <option value="databasedesign">Database Design and Development</option>
        <option value="infosystemsmgmt">Information Systems Management</option>
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		<option value="networkdesign">Network Design - Development</option>
        <option value="systemsanalyst">Systems Analyst</option>
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	   <option value="all" selected="selected">- Select All Degrees -</option>
		<option value="associate">Associate's</option>
		<option value="bachelor">Bachelor's</option>
		<option value="master">Master's</option>
		<option value="doctoral">Doctoral</option>
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		<option value="diploma">Diplomas</option>
		<option value="coursework">Coursework</option>
		<option value="mba">MBA</option>
	  </select>
	<br style="clear:both;"/><br/>  
	 <input name="ct" type="radio" value="online"  placeholder="disabled" disabled="disabled" title="form boxes are disabled in cached version of the site" value="Disabled" style="opacity:0.3;" />Online
	  <input name="ct" type="radio" value="campus"  placeholder="disabled" disabled="disabled" title="form boxes are disabled in cached version of the site" value="Disabled" style="opacity:0.3;" />Campus
	  <input name="ct" type="radio" value="either" checked="checked" placeholder="disabled" disabled="disabled" title="form boxes are disabled in cached version of the site" value="Disabled" style="opacity:0.3;" />Both
      
	  <br/><br/> 
	  <input type="submit" value="Submit"  placeholder="disabled" disabled="disabled" title="form boxes are disabled in cached version of the site" value="Disabled" style="opacity:0.3;" />	
</form></div>
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