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<h1>Kontakt</h1>
<br/>
<script type="text/javascript" src="http://maps.google.com/maps/api/js?sensor=false"></script>
<script type="text/javascript">
function initialize() {
var latlng = new google.maps.LatLng(53.72873, 10.257556);
var myOptions = {
zoom: 15,
center: latlng,
mapTypeId: google.maps.MapTypeId.ROADMAP
};
var map = new google.maps.Map(document.getElementById("map_canvas"), myOptions);
marker = new google.maps.Marker({
map: map,
position: latlng
});
marker.setVisible(true);
}
window.onload = initialize;
</script>
<div id="map_canvas"></div>
<form id="kontaktf" action="kontaktformularverarbeitung01.php" method="post">
<table>
<tr>
<td>Name:</td>
<td><input name="name" size="26"/></td>
</tr>
<tr>
<td>E-Mail:</td>
<td><input name="email" size="26"/></td>
</tr>
<tr>
<td>Tel.Nr:</td>
<td><input name="tel" size="26"/></td>
</tr>
</table>
<br/>
<select name="betreff" size="1">Betreff
<option>Allgemeine Frage</option>
<option>Hautkrebsvorsorge</option>
<option>Normaler Termin</option>
<option>Rezeptwunsch</option>
<option>Ruckruf Bitte</option>
<option>Sonstiges</option>
</select><br/>
Nachricht: <br/>
<textarea name="text" cols="51" rows="10"></textarea><br/>
<input name="submit" type="submit" value="absenden"/>
</form>
<br/>
<table class="tablestart2">
<tr>
<td>Jersbeker Straße 5</td>
<td class="Re">Tel: +49 45 32-80 59</td>
</tr>
<tr>
<td>22941 Bargteheide</td>
<td class="Re">Fax: +49 45 32-80 09</td>
</tr>
</table>