document.write("<form name='form2' method='get' action='http://www.bomi.info/practitioners/results.asp'><div align='center'><table border='0'><tr><td align='right'><font face='Verdana, Arial, Helvetica, sans-serif' size='1'>by <b>Specialty</b>:</font> </td><td colspan='2'><input name='what' type='text'  value='' size='30' class='practtext-sm'></td></tr><tr><td><font face='Verdana, Arial, Helvetica, sans-serif' size='1'>and/or by <b>Location</b>:</font></td><td><input name='where' type='text'  value='' size='18' class='practtext-sm'></td><td align='right'><input type='submit' value='Search' class='practbut' name='submit'></td><td align='right'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</td></tr></table></div></form>");