document.write("<div style='background-color:#ecedef; padding:0px 0 8px 0;'> ")
    document.write("<img src=/images/findADoctorInner.png />")
    document.write("<form id=frmFAF action=/find-a-doctor/search-results name=frmFAF method=POST style='margin: -38px 0 0 48px;'>")
    document.write("<p style=padding: 0; margin: 0 0 0 48px;>Street, City & State, or Zip")
    document.write("<input id=txtAddress name=txtAddress runat=server  /></p>")
    document.write("<p>")
    document.write("<select name=selRadius id=selRadius size=1 style=margin-left:0px;>")
    document.write("<option value=5>5 miles</option>")
    document.write("<option value=10>10 miles</option>")
    document.write("<option value=15>15 miles</option>")
    document.write("<option value=25>25 miles</option>")
    document.write("</select>")
    document.write("</p>")
    document.write("<p>")
    document.write("<input type=image id=btnSearch src=/images/btnSearch.gif name=btnSearch runat=server style=margin-left:0px;/>" )
    document.write("</p>")
    document.write("</form>")
    document.write("</div>")