var randomnumber=generateId(7);
var formid=generateId(4);
var referrer=document.referrer;
document.write("<style type=\"text/css\">#af-form-2143381725 .af-body .af-textWrap, #af-form-2143381725 .choiceList-radio-inline, #af-form-2143381725 .choiceList-radio-stacked{width:98%;display:block;float:none;}#af-form-2143381725 .af-body a{color:#9C1919;text-decoration:underline;font-style:normal;font-weight:normal;}#af-form-2143381725 .af-body input.text, #af-form-2143381725 .af-body textarea{background-color:#FFFFFF;border-color:#B3A26F;border-width:1px;border-style:solid;color:#000000;text-decoration:none;font-style:normal;font-weight:normal;font-size:12px;font-family:Verdana, sans-serif;}#af-form-2143381725 .af-body input.text:focus, #af-form-2143381725 .af-body textarea:focus{background-color:#FFFAD6;border-color:#030303;border-width:1px;border-style:solid;}#af-form-2143381725 .af-body label.choice{color:inherit;text-decoration:none;font-style:normal;font-weight:normal;font-size:inherit;font-family:inherit;}#af-form-2143381725 .af-body 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.af-quirksMode{padding-right:15px;padding-left:15px;}#af-form-2143381725 .af-standards .af-element{padding-right:15px;padding-left:15px;}#af-form-2143381725 .bodyText p{margin:1em 0;}#af-form-2143381725 .buttonContainer input.submit{background-image:url(\"images/eee.png\");background-position:top left;background-repeat:repeat-x;background-color:#bfbfbf;border:1px solid #bfbfbf;color:#000000;text-decoration:none;font-style:normal;font-weight:normal;font-size:12px;font-family:Verdana, sans-serif;}#af-form-2143381725 .buttonContainer input.submit{width:auto;}#af-form-2143381725 .buttonContainer{text-align:left;}#af-form-2143381725 .choiceList-radio-inline .af-element-radio{margin-right:0px;}#af-form-2143381725 body,#af-form-2143381725 dl,#af-form-2143381725 dt,#af-form-2143381725 dd,#af-form-2143381725 h1,#af-form-2143381725 h2,#af-form-2143381725 h3,#af-form-2143381725 h4,#af-form-2143381725 h5,#af-form-2143381725 h6,#af-form-2143381725 pre,#af-form-2143381725 code,#af-form-2143381725 fieldset,#af-form-2143381725 legend,#af-form-2143381725 blockquote,#af-form-2143381725 th,#af-form-2143381725 td{float:none;color:inherit;position:static;margin:0;padding:0;}#af-form-2143381725 button,#af-form-2143381725 input,#af-form-2143381725 submit,#af-form-2143381725 textarea,#af-form-2143381725 select,#af-form-2143381725 label,#af-form-2143381725 optgroup,#af-form-2143381725 option{float:none;position:static;margin:0;}#af-form-2143381725 div{margin:0;}#af-form-2143381725 fieldset{border:0;}#af-form-2143381725 form,#af-form-2143381725 textarea,.af-form-wrapper,.af-form-close-button,#af-form-2143381725 img{float:none;color:inherit;position:static;background-color:none;border:none;margin:0;padding:0;}#af-form-2143381725 input,#af-form-2143381725 button,#af-form-2143381725 textarea,#af-form-2143381725 select{font-size:100%;}#af-form-2143381725 p{color:inherit;}#af-form-2143381725 select,#af-form-2143381725 label,#af-form-2143381725 optgroup,#af-form-2143381725 option{padding:0;}#af-form-2143381725 table{border-collapse:collapse;border-spacing:0;}#af-form-2143381725 ul,#af-form-2143381725 ol{list-style-image:none;list-style-position:outside;list-style-type:disc;padding-left:40px;}#af-form-2143381725,#af-form-2143381725 .quirksMode{width:305px;}#af-form-2143381725.af-quirksMode{overflow-x:hidden;}#af-form-2143381725{background-color:#FFFAF2;border-color:#AD9A9A;border-width:1px;border-style:solid;}#af-form-2143381725{overflow:hidden;}.af-body .af-textWrap{text-align:left;}.af-body input.image{border:none!important;}.af-body input.submit,.af-body input.image,.af-form .af-element input.button{float:none!important;}.af-body input.text{width:100%;float:none;padding:2px!important;}.af-body.af-standards input.submit{padding:4px 12px;}.af-clear{clear:both;}.af-element input.radio{width:inherit!important;}.af-element label{text-align:left;display:block;float:left;}.af-element-radio label,.af-element-radio input.radio{display:inline!important;float:none!important;}.af-element-radio label{display:inline;}.af-element-radio.inline{float:left;margin-left:0;margin-right:7px;}.af-element.radio{display:block!important;}.af-element{padding:5px 0;}.af-form-wrapper{text-indent:0;}.af-form{text-align:left;margin:auto;}.af-header{margin-bottom:0;margin-top:0;padding:10px;}.af-quirksMode .af-element{padding-left:0!important;padding-right:0!important;}.choiceList-radio-inline .af-element-radio{float:left;}.lbl-right .af-element label{text-align:right;}body {}</style><form method=\"post\" class=\"af-form-wrapper\" action=\"hwnd-general-post.php\" name=\"frmRequest2"+formid+"\" onsubmit=\"return checkform(this);\"  ><div style=\"display: none;\"><input type=\"hidden\" name=\"hidreffer\" value=\""+referrer+"\" /><input type=\"hidden\" name=\"meta_web_form_id\" value=\"2143381725\" /><input type=\"hidden\" name=\"meta_split_id\" value=\"\" /><input type=\"hidden\" name=\"listname\" value=\"contactnbh\" /><input type=\"hidden\" name=\"redirect\" value=\"http://www.lifetimehealthweightloss.com/contactform-thankyou\" id=\"redirect_ef24096c211e2d906a4a45db56112fa0\" /><input type=\"hidden\" name=\"meta_adtracking\" value=\"Lifetime_Health_Weight_Loss_-_Organic\" /><input type=\"hidden\" name=\"meta_message\" value=\"1\" /><input type=\"hidden\" name=\"meta_required\" value=\"name,email,custom Phone,custom When is the best time to call you to schedule a FREE Consultation\" /><input type=\"hidden\" name=\"meta_forward_vars\" value=\"\" /><input type=\"hidden\" name=\"meta_tooltip\" value=\"custom Phone||555-555-5555\" /></div><div id=\"af-form-2143381725\" class=\"af-form\"><div id=\"af-header-2143381725\" class=\"af-header\"><div class=\"bodyText\"><p style=\"text-align: center;\"><span style=\"font-size: 12px;\"><span style=\"color: #000000;\"><strong>Schedule Your <span style=\"color: #000000;\">FREE CONSULTATION</span><br /></strong></span><span style=\"color: #000000;\"><strong>Call <span style=\"color: #800000;\">512-961-4598</span> Today<br />or Fill Out the Form Below.</strong></span></span></p></div></div><div id=\"af-body-2143381725\" class=\"af-body af-standards\"><div class=\"af-element\"><label class=\"previewLabel\" for=\"awf_field-5544992\">Name:*</label><div class=\"af-textWrap\"><input id=\"awf_field-5544992\" type=\"text\" name=\"name\" class=\"text\" value=\"\"  /></div><div class=\"af-clear\"></div></div><div class=\"af-element\"><label class=\"previewLabel\" for=\"awf_field-5544993\">Email:* (We Respect Your Privacy) </label><div class=\"af-textWrap\"><input class=\"text\" id=\"awf_field-5544993\" type=\"text\" name=\"email\" value=\"\"  /></div><div class=\"af-clear\"></div></div><div class=\"af-element\"><label class=\"previewLabel\" for=\"awf_field-5544994\">Phone:* </label><div class=\"af-textWrap\"><input type=\"text\" id=\"awf_field-5544994\" class=\"text\" name=\"Phone\" value='555-555-5555'  onfocus=\" if (this.value == '555-555-5555') { this.value = ''; }\" onblur=\"if (this.value == '') { this.value='555-555-5555';} \" /></div><div class=\"af-clear\"></div></div>   <div class=\"af-element\"><div><label class=\"previewLabel\">When is the best time to call you to schedule a FREE Consultation?*</label><div class=\"choiceList choiceList-radio-stacked\"><div class=\"af-element-radio multiChoice\"><input class=\"radio\" type=\"radio\" id=\"awf_field-55449950\" name=\"optBestTime\"  value=\"8am - Noon\" /><label class=\"choice\" for=\"awf_field-55449950\">8am - Noon</label><div class=\"af-clear\"></div></div><div class=\"af-element-radio multiChoice\"><input class=\"radio\" type=\"radio\" id=\"awf_field-55449951\" name=\"optBestTime\"  value=\"Noon - 5pm\" /><label class=\"choice\" for=\"awf_field-55449951\">Noon - 5pm</label><div class=\"af-clear\"></div></div></div></div><div class=\"af-clear\"></div></div>  <!--start captcha-->  <input type=\"hidden\"  name=\"hiddencaptcha\" value=\""+randomnumber+"\"> <input type=\"hidden\"  name=\"hiddencaptchaid\" value=\""+formid+"\"> <div class=\"af-element\"><label class=\"previewLabel\" for=\"awf_field-5544992\">Enter the characters below:*</label><div class=\"af-textWrap\"><input id=\"awf_field-5544992\" type=\"text\" name=\"txtcaptcha\" class=\"text\" value=\"\"  /></div><div class=\"af-clear\"></div></div>           <div class=\"af-element\"><img style=\"float:left; margin-left:30px;\" src=\"/captcha.php?str="+randomnumber+"&strcaptcha="+formid+"\" /><div class=\"af-clear\"></div></div>  <!--end captcha-->  <div class=\"af-element buttonContainer\"><input name=\"submit\" class=\"submit\" type=\"submit\" value=\"Schedule  Now\"/><div class=\"af-clear\"></div></div><div class=\"af-element\"><div class=\"bodyText\"><p>*required field</p></div><div class=\"af-clear\"></div></div></div></div></form><script type=\"text/javascript\">    <!--    (function() {        var IE = /*@cc_on!@*/false;        if (!IE) { return; }        if (document.compatMode && document.compatMode == 'BackCompat') {            if (document.getElementById(\"af-form-2143381725\")) {                document.getElementById(\"af-form-2143381725\").className = 'af-form af-quirksMode';            }            if (document.getElementById(\"af-body-2143381725\")) {                document.getElementById(\"af-body-2143381725\").className = \"af-body inline af-quirksMode\";            }            if (document.getElementById(\"af-header-2143381725\")) {                document.getElementById(\"af-header-2143381725\").className = \"af-header af-quirksMode\";            }            if (document.getElementById(\"af-footer-2143381725\")) {                document.getElementById(\"af-footer-2143381725\").className = \"af-footer af-quirksMode\";            }        }    })();    --></script>");

function checkform(frmrequest){
		
	if(trim(frmrequest.name.value)==""){
		alert("Please enter name");	
		frmrequest.name.focus();
		return false;
	}
	
	if(trim(frmrequest.email.value)==""){
		alert("Please enter email");	
		frmrequest.email.focus();
		return false;
	}
	
	if(trim(frmrequest.Phone.value)=="" || trim(frmrequest.Phone.value)=="555-555-5555"){
		alert("Please enter phone");	
		frmrequest.Phone.focus();
		return false;
	}
	
	var bval=true;
	
	bval=emailCheck(trim(frmrequest.email.value));
	if(bval){
		bval=PhoneCheck(trim(frmrequest.Phone.value));
	}
	
	
	
	if(bval && frmrequest.txtcaptcha.value!=frmrequest.hiddencaptcha.value) {
	 	alert("Please type characters properly");
		bval=false;
	 }
	
	return bval;
	
}

function emailCheck(emailStr) {
	var emailPat=/^(.+)@(.+)$/
	var matchArray;	
	
	if(emailStr.length > 1)	{  	  	
		matchArray = emailStr.match(emailPat);
		if (matchArray == null){
			alert("Please Enter Correct Email Address"); 
			return false;
		}else{
			return true;
		}  		
	}				
}

function PhoneCheck(strPhone){  	  		  	  		
	strPhone=strPhone.replace(/[^0-9]/g, ''); 
	//if(strPhone.length
	if(strPhone.length!=10){
		alert("Invalid Phone Number");
		return false;
	}
	return true;	  	  	
}

function trim(stringToTrim) {
	return stringToTrim.replace(/^\s+|\s+$/g,"");
}

<!--Code for captcha-->
function generateId(varlength){	
	var id="";
	var rnd;
	var type;
	for(i=0; i<varlength; i++){
		rnd=getRandomInt(0,1)? Chr(getRandomInt(48, 57)) : Chr(getRandomInt(97, 122))
		id=id + String(rnd);										
	}	
	return id;
}

function Asc(String){
	return String.charCodeAt(0);
}

function Chr(AsciiNum){
	return String.fromCharCode(AsciiNum);
}

function getRandomInt (min, max) { 
    return Math.floor(Math.random() * (max - min + 1)) + min; 
} 
<!--Code for captcha-->