<div>

<ul>

 <form id="myform" method="post" action="http://m.wangjinhai119.com/plus/diy.php" name="myform" onsubmit="return checkForm()" enctype="multipart/form-data">

<input type="hidden" name="action" value="post" />

<input type="hidden" name="diyid" value="1" />

<input type="hidden" name="do" value="2" />

<input type="hidden" name="required" value="name,tel,ystime,keshi,remark" />

<li>姓名：<input  type="text" id="name" name='name' value=""  style="width:150px;height:22px; line-height:23px; border:1px solid #dbd5cd; background:#ffffff; padding-top:2px;color:#888888" >

<field:name  isnull="true" itemname="姓名"></field:name>

</li>

<li>时间：<input type="text" id="ystime" name='ystime'   onBlur="if (value=='') {value='请填写您的预约时间'} "  onFocus="if(value=='请填写您的预约时间') {value=''}" value="请填写您的预约时间"  style="width:150px;height:22px; line-height:23px; border:1px solid #dbd5cd; background:#ffffff; padding-top:2px;color:#888888"  title="点击选择" onClick="fPopCalendar(event,this,this)" onFocus="this.select()" readonly="readonly"  >

</li>

<li>电话：<input type="text" id="tel" name="tel" value=""  style="width:150px;height:22px; line-height:23px; border:1px solid #dbd5cd; background:#ffffff; padding-top:2px;color:#888888" ></li>

<li>科室：                 

<select name='keshi' ><option value='前列腺'>前列腺</option>

<option value='性功能障碍'>性功能障碍</option>

<option value='生殖感染'>生殖感染</option>

<option value='生殖整形'>生殖整形</option>

<option value='男性不育'>男性不育</option>

</select>                

</li>

<li>说明：<textarea class="tex1" name="remark" id="remark"></textarea></li>

<li><input type="submit" name="submit" id="dosubmit" style="width:93px; height:29px;background:url(http://m.wangjinhai119.com/images/tj.jpg) center top no-repeat; border:0; cursor:pointer" value="  ">

</li>

</ul>

<input type="hidden" name="dede_fields" value="name,text;tel,text;ystime,datetime;keshi,select;remark,multitext" />

<input type="hidden" name="dede_fieldshash" value="11eb10e09fd6640396dc66045c43b46f" />

</form>

</div>