function VerifySubmission() {
	
		var SubmitFlag;
		var ErrorMessage;
		var Day;
		var Month;
		var myDate; 

		
		SubmitFlag = false;
		ErrorMessage = "";
		
		if (document.request.FirstName.value == "") {
			alert("Please enter your first name.");
			document.request.FirstName.focus();
			return;
		}
		
		if (document.request.LastName.value == "") {
			alert("Please enter your last name.");
			document.request.LastName.focus();
			return;
		}
		
		if (document.request.AddressLineOne.value == "") {
			alert("Please enter your mailing address.");
			document.request.AddressLineOne.focus();
			return;
		}
		
		if (document.request.City.value == "") {
			alert("Please enter a city for your mailing address.");
			document.request.City.focus();
			return;
		}
		
		if (!document.request.State.selectedIndex) {
			alert("Please enter a state for your mailing address.");
			document.request.State.focus();
			return;
		}
		
		if (document.request.ZipCode.value == "") {
			alert("Please enter a zip code for your mailing address.");
			document.request.ZipCode.focus();
			return;
		}
				
		if (document.request.PrimaryPhoneNumberAreaCode.value == "") {
			alert("Please enter an area code for your primary phone number.");
			document.request.PrimaryPhoneNumberAreaCode.focus();
			return;
		}
				
		if (document.request.PrimaryPhoneNumberPrefix.value == "") {
			alert("Please enter a prefix for your primary phone number.");
			document.request.PrimaryPhoneNumberPrefix.focus();
			return;
		}
				
		if (document.request.PrimaryPhoneNumberSuffix.value == "") {
			alert("Please enter the last four digits of your primary phone number.");
			document.request.PrimaryPhoneNumberSuffix.focus();
			return;
		}
			
		if (document.request.DateOfBirthMonth.options[document.request.DateOfBirthMonth.selectedIndex].value == "") {
			alert("Please select a month for your date of birth.");
			document.request.DateOfBirthMonth.focus();
			return;
		}
		
		if (document.request.DateOfBirthDay.options[document.request.DateOfBirthDay.selectedIndex].value == "") {
			alert("Please select a day for your date of birth.");
			document.request.DateOfBirthDay.focus();
			return;
		}
		
		if (document.request.DateOfBirthYear.value == "") {
			alert("Please enter a four digit year for your date of birth.");
			document.request.DateOfBirthYear.focus();
			return;
		}

		Day = document.request.DateOfBirthDay.options[document.request.DateOfBirthDay.selectedIndex].value;
		Month = document.request.DateOfBirthMonth.options[document.request.DateOfBirthMonth.selectedIndex].value;
		if (isDate(Month+'-'+Day+'-'+document.request.DateOfBirthYear.value) == false) {
			alert("Please enter a valid date of birth.");
			document.request.DateOfBirthMonth.focus();
			return;
		}

		if (!(document.request.Gender[0].checked || document.request.Gender[1].checked)) {
			alert("Please indicate your gender.");
			return;
		}

		if (document.request.EmailAddress.value == "") {
			alert("Please enter your email address.");
			document.request.EmailAddress.focus();
			return;
		}
		else if (!echeck(document.request.EmailAddress.value)) {
			alert("Please enter a valid email address.");
			document.request.EmailAddress.focus();
			return;
		}

		if (!(document.request.IsNewPatient[0].checked || document.request.IsNewPatient[1].checked)) {
			alert("Please indicate if you are new patient.");
			return;
		}

		if (document.request.InsuranceCompany.value == "") {
			alert("Please enter the name of your insurance company.");
			document.request.InsuranceCompany.focus();
			return;
		}

		if (document.request.ReasonForVist.value == "") {
			alert("Please enter the reason you would like an appointment.");
			document.request.ReasonForVist.focus();
			return;
		}

		if (document.request.AppointmentOptionOneDateMonth.options[document.request.AppointmentOptionOneDateMonth.selectedIndex].value == "") {
			alert("Please select a month for your prefered appointment date.");
			document.request.AppointmentOptionOneDateMonth.focus();
			return;
		}
		
		if (document.request.AppointmentOptionOneDateDay.options[document.request.AppointmentOptionOneDateDay.selectedIndex].value == "") {
			alert("Please select a day for your prefered appointment date.");
			document.request.AppointmentOptionOneDateDay.focus();
			return;
		}
		
		if (document.request.AppointmentOptionOneDateYear.value == "") {
			alert("Please enter a four digit year for your prefered appointment date.");
			document.request.AppointmentOptionOneDateYear.focus();
			return;
		}

		Day = document.request.AppointmentOptionOneDateDay.options[document.request.AppointmentOptionOneDateDay.selectedIndex].value;
		Month = document.request.AppointmentOptionOneDateMonth.options[document.request.AppointmentOptionOneDateMonth.selectedIndex].value;
		if (isDate(Month+'-'+Day+'-'+document.request.AppointmentOptionOneDateYear.value) == false) {
			alert("Please enter a valid date for your prefered appointment date.");
			document.request.AppointmentOptionOneDateDay.focus();
			return;
		}

		myDate = new Date(Month+'-'+Day+'-'+document.request.AppointmentOptionOneDateYear.value);
		if (myDate <= new Date()) {
			alert("Please enter a date in the future for your prefered appointment date.");
			document.request.AppointmentOptionOneDateDay.focus();
			return;
 		}

		if (!document.request.AppointmentOptionOneTimeInterval.selectedIndex) {
			alert("Please choose a prefered time of day for your appointment.");
			document.request.AppointmentOptionOneTimeInterval.focus();
			return;
		}
		

		if (document.request.AppointmentOptionTwoMonth.options[document.request.AppointmentOptionTwoMonth.selectedIndex].value == "") {
			alert("Please select a month for your first alternative appointment date.");
			document.request.AppointmentOptionTwoMonth.focus();
			return;
		}
		
		if (document.request.AppointmentOptionTwoDay.options[document.request.AppointmentOptionTwoDay.selectedIndex].value == "") {
			alert("Please select a day for your first alternative appointment date.");
			document.request.AppointmentOptionTwoDay.focus();
			return;
		}
		
		if (document.request.AppointmentOptionTwoYear.value == "") {
			alert("Please enter a four digit year for your first alternative appointment date.");
			document.request.AppointmentOptionTwoYear.focus();
			return;
		}

		Day = document.request.AppointmentOptionTwoDay.options[document.request.AppointmentOptionTwoDay.selectedIndex].value;
		Month = document.request.AppointmentOptionTwoMonth.options[document.request.AppointmentOptionTwoMonth.selectedIndex].value;
		if (isDate(Month+'-'+Day+'-'+document.request.AppointmentOptionTwoYear.value) == false) {
			alert("Please enter a valid date for your first alternative appointment date.");
			document.request.AppointmentOptionTwoDay.focus();
			return;
		}

		myDate = new Date(Month+'-'+Day+'-'+document.request.AppointmentOptionTwoYear.value);
		if (myDate <= new Date()) {
			alert("Please enter a date in the future for your first alternative appointment date.");
			document.request.AppointmentOptionTwoMonth.focus();
			return;
 		}

		if (!document.request.AppointmentOptionTwoTimeInterval.selectedIndex) {
			alert("Please choose a prefered time of day for your first alternative appointment.");
			document.request.AppointmentOptionTwoTimeInterval.focus();
			return;
		}
		

		if (document.request.AppointmentOptionThreeMonth.options[document.request.AppointmentOptionThreeMonth.selectedIndex].value == "") {
			alert("Please select a month for your second alternative appointment date.");
			document.request.AppointmentOptionThreeMonth.focus();
			return;
		}
		
		if (document.request.AppointmentOptionThreeDay.options[document.request.AppointmentOptionThreeDay.selectedIndex].value == "") {
			alert("Please select a day for your second alternative appointment date.");
			document.request.AppointmentOptionThreeDay.focus();
			return;
		}
		
		if (document.request.AppointmentOptionThreeYear.value == "") {
			alert("Please enter a four digit year for your second alternative appointment date.");
			document.request.AppointmentOptionThreeYear.focus();
			return;
		}

		Day = document.request.AppointmentOptionThreeDay.options[document.request.AppointmentOptionThreeDay.selectedIndex].value;
		Month = document.request.AppointmentOptionThreeMonth.options[document.request.AppointmentOptionThreeMonth.selectedIndex].value;
		if (isDate(Month+'-'+Day+'-'+document.request.AppointmentOptionThreeYear.value) == false) {
			alert("Please enter a valid date for your second alternative appointment date.");
			document.request.AppointmentOptionThreeDay.focus();
			return;
		}

		myDate = new Date(Month+'-'+Day+'-'+document.request.AppointmentOptionThreeYear.value);
		if (myDate <= new Date()) {
			alert("Please enter a date in the future for your second alternative appointment date.");
			document.request.AppointmentOptionTwoMonth.focus();
			return;
 		}

		if (!document.request.AppointmentOptionThreeTimeInterval.selectedIndex) {
			alert("Please choose a prefered time of day for your second alternative appointment.");
			document.request.AppointmentOptionThreeTimeInterval.focus();
			return;
		}
		

		document.request.submit();

	}

	function isDate(dateStr) {
	
		var datePat = /^(\d{1,2})(\/|-)(\d{1,2})(\/|-)(\d{4})$/;
		var matchArray = dateStr.match(datePat); // is the format ok?
		
		if (matchArray == null) {
//		alert("Please enter date as either mm/dd/yyyy or mm-dd-yyyy.");
		return false;
		}
			
		month = matchArray[1]; // parse date into variables
		day = matchArray[3];
		year = matchArray[5];
		
		if (month < 1 || month > 12) { // check month range
//		alert("Month must be between 1 and 12.");
		return false;
		}
		
		if (day < 1 || day > 31) {
///		alert("Day must be between 1 and 31.");
		return false;
		}
		
		if ((month==4 || month==6 || month==9 || month==11) && day==31) {
		alert("Month "+month+" doesn`t have 31 days!")
		return false;
		}
		
		if (month == 2) { // check for february 29th
			var isleap = (year % 4 == 0 && (year % 100 != 0 || year % 400 == 0));
			if (day > 29 || (day==29 && !isleap)) {
			alert("February " + year + " doesn`t have " + day + " days!");
			return false;
			}
		}
		
		return true; // date is valid
	}



	function echeck(str) {

		var at="@"
		var dot="."
		var lat=str.indexOf(at)
		var lstr=str.length
		var ldot=str.indexOf(dot)
		if (str.indexOf(at)==-1){
	//	   alert("Invalid E-mail ID")
		   return false
		}

		if (str.indexOf(at)==-1 || str.indexOf(at)==0 || str.indexOf(at)==lstr){
		//   alert("Invalid E-mail ID")
		   return false
		}

		if (str.indexOf(dot)==-1 || str.indexOf(dot)==0 || str.indexOf(dot)==lstr){
	//	    alert("Invalid E-mail ID")
		    return false
		}

		 if (str.indexOf(at,(lat+1))!=-1){
	//	    alert("Invalid E-mail ID")
		    return false
		 }

		 if (str.substring(lat-1,lat)==dot || str.substring(lat+1,lat+2)==dot){
	//	    alert("Invalid E-mail ID")
		    return false
		 }

		 if (str.indexOf(dot,(lat+2))==-1){
	//	    alert("Invalid E-mail ID")
		    return false
		 }
		
		 if (str.indexOf(" ")!=-1){
//		    alert("Invalid E-mail ID")
		    return false
		 }

 		 return true					
	}