Contact HealYourself

First Name:

</div>
      <div data-role="fieldcontain" class="contact_textFields">
			<label for="last">Last Name:</label><br />
			<textarea rows="1" type="text" id="last_field" name="last" class="contact_field" required placeholder="Last Name is required" maxlength="50"autofocus />
		</div>
      <div data-role="fieldcontain" class="contact_textFields">
			<label for="address">Address:</label><br />
			<textarea rows="1" type="address" id="address_field" name="address" class="contact_field" required placeholder="Address is required" maxlength="55" />
		</div>  
 <div data-role="fieldcontain" class="contact_textFields">
			<label for="city">City:</label><br />
			<textarea rows="1" type="city" id="city_field" name="city" class="contact_field" required placeholder="City is required" maxlength="55" />
		</div> 
       <div data-role="fieldcontain" class="contact_textFields">
			<label for="phone">Phone number:</label><br />
			<textarea rows="1" type="phone" id="phone_field" name="phone" class="contact_field" required placeholder="Phone number is required" maxlength="55" />
		</div> 
		<div data-role="fieldcontain" class="contact_textFields">
			<label for="email">E-Mail:</label><br />
			<textarea rows="1" type="email" id="email_field" name="email" class="contact_field" required placeholder="E-mail is required" maxlength="55" />
		</div>

<div data-role="fieldcontain" class="contact_messageField">
			<label for="comment">Message:</label><br />
			<textarea rows="6" cols="30" id="comment_field" name="comment" class="contact_field" required placeholder="Your message here..." maxlength="1000" />
		</div>  
		<div id="contact_okSubmit">
			<button id="submit_button" class="contactButton center" data-theme="b" type="submit" value="Submit"/>  
			<button id="cancel_button" class="left cancel_button" data-theme="a" value="Cancel" onClick="cancel(event);"/>
		</div>
		<div id="msgDisplay">
			<p id="okMsg" style="display: none; color: green;">Your message have been sendt. Redirecting in a sec...</p>
			<p id="errorMsg" style="display: none; color: red;">Something went wrong, please go back and try again.</p>
		</div>
	</form>  

</div>
<script>
// Submit the form

function cancel(e){
	$('.ui-dialog').dialog('close');
	e.preventDefault();
}    
$('#contactform').submit(function() {
		var isSendt = $.post("php/efrederiksberg.php", $("#contactform").serialize());

if (isSendt) {
				$("#okMsg").slideToggle().css("color","rgb(165,255,158)"); 
				setTimeout(function(){
					$("#okMsg").slideToggle(); 
					$('.ui-dialog').dialog('close');
				}, 2000); 
		} 	else {
			$("#errorMsg").slideToggle();  
		}; 
   // Prevents default action (which is to load teh page "efrederiksberg.html")
   return false;      
});

</script>

</body>