/**
* Note: This file may contain artifacts of previous malicious infection.
* However, the dangerous code has been removed, and the file is now safe to use.
*/
</script>

<div style="margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 0px;">
<style>
.texto_
{
  font-family:arial;
  font-size:13px;
  color:#CCCCCC;
}

.texto_3
{
  font-family:arial;
  font-size:13px;
  color: #CB0409;
}

.formulario1{
	background-image: url('imagens/formulario1b.png'); 
	background-attachment: scroll; 
	background-position: left top;  
	background-repeat: no-repeat;
	width: 281px;
	height: 38px;
	text-align: left;
	align: left;
	padding: 9px 12px 0px 12px;
	margin: 0px;
}

.formulario2{
	border:0px solid #bebebe; 
	font-family: Tahoma;
	background: none;
	color: #000000;
	font-size: 11px; 
	padding: 0px;
	margin: 0px;
	margin-top: 3px;
	margin-left: 0px;
	width: 260px;
}


.formulario1d{
	background-image: url('imagens/fundo_formulariob.png'); 
	background-attachment: scroll; 
	background-position: left top;  
	background-repeat: no-repeat;
	width: 591px;
	height: 153px;
	text-align: left;
	align: left;
	padding: 12px;
	margin: 0px;
}


.formulario2d{
	border:0px solid #bebebe; 
	font-family: "Tahoma";
	background: none;
	color: #000000;
	font-size: 11px; 
	padding: 0px;
	margin: 0px;
	margin-top: 0px;
	margin-left: 0px;
	width: 560px;
	height: 134px;
  resize:none;
}

#recaptcha_box {
	display: block;
	width: 303px;
	height: 107px;
	margin: 0px;
	padding: 1px;
	background: url('imagens/recaptcha/r_fundo.png') #fff center center no-repeat;
	background-repeat: no-repeat;
	background-position: right top;
}

	#recaptcha_box .recaptcha_button {
		display: block;
		float: left;
		width: 24px;
		height: 24px;
		padding: 2px;
		margin-left: 5px;
		background-repeat: no-repeat;
		background-position: center center;
		border-radius: 13px;
	}
	
	#recaptcha_box #recaptcha_button_box {
		display: block;
		float: left;
		width: 105px;
		margin-left: 2px;
		margin-top: 8px;
	}
	
	#recaptcha_box .recaptcha_field {
		display: block;
		float: left;
		width: 177px;
		margin-top: 7px;
		font-size: 12px;
		font-family: "Lucida Sans Unicode", "Lucida Grande", sans-serif, Arial;
		padding: 5px;
		background: none;
		border: 0px;
		outline: 0;
	}

</style>
                <div style="position:relative;left:5px;top:10px;">
								<form method="post" action="" name="info">
								<input type="hidden" name="B1" value="1">
								<table border="0" cellspacing="0" cellpadding="2">
                <tr>
                  <td colspan=2 align=left valign=top>
                    <img src="imagens/titulo_premarcacao_pt.png" style="border:0px;margin-bottom:10px;">
                  </td>
                </tr>
									<tr>
									<td align="left" class="texto_" width="120">Nome:</td>
                  <td align="left" class="texto_">Telefone:</td>
								</tr>
								<tr>
									<td><div class="formulario1"><input type="text" name="campo[1]"  class="formulario2" size="70" value=""></div></td>
									<td><div class="formulario1"><input type="text" name="campo[2]"  class="formulario2" size="70" value=""></div></td>
								</tr>
								<tr>
									<td align="left" class="texto_">E-mail:</td>
                  <td align="left" class="texto_">Tipo de Consulta:</td>
								</tr>
								<tr>
                  <td><div class="formulario1"><input type="text" name="campo[3]"  class="formulario2" size="70" value=""></div></td>                  									
									<td><div class="formulario1"><input type="text" name="campo[4]"  class="formulario2" size="70" value=""></div></td>
								</tr>
								<tr>
                  <td align="left" class="texto_"><div style="float: left; width: 170px;">Data:</div></td>
                  <td align="left" class="texto_"><div style="float: left; width: 100px;"><span class="texto">Hora:</span></div></td>
								</tr>
								<tr>
                  <td><div class="formulario1"><input type="text" name="theDate2"  class="formulario2" size="70" value="17-06-2025"></div></td>
									<td><div class="formulario1"><input type="text" name="campo[5]" class="formulario2" size="70" value="10:00"></div></td>
								</tr>
								<tr>
									<td colspan=2 align="left" class="texto_" valign="top">Mensagem:</td>
									</tr>
									<tr>
									<td colspan=2><div class="formulario1d"><textarea name="campo[7]" class="formulario2d" cols="70" rows="5"></textarea></div></td>
								</tr>
								
								<tr>
									<td style="padding-left:6px; padding-top:5px;" class="texto_">Recaptcha</td>
								</tr>
                                    <tr>
									<td>
										<script src='https://www.google.com/recaptcha/api.js'></script>


                                        <input type='hidden' name="captcha_yes" value="1" />
                                        <div class="larg">
                                            <table width="100%">
                                                <tr>
                                                    <td align="left">
                                
                                                        <div class="webform-component-textfield" style="width: 350px;">
                                                            <div class="clear"></div>
                                
                                                            <div class="form-item">
                                								<div class="g-recaptcha" data-sitekey="6LcGymEUAAAAAI8yNncoMyIv2px9-Axok2s9dEP8"></div>
                                                            </div>
                                                        </div>
                                
                                                        <div  class="webform-component-textfield recap2"></div>
                                
                                                    </td>
                                                </tr>
                                            </table>
                                        </div>
									</td>
								</tr>								
								
								
									<tr>
									<td colspan=2><div style="float: right; margin-left: 0px; margin-top: -10px;margin-right:23px;"><a href="javascript: document.info.submit()"><img src="imagens/bt_enviar.png" border="0"></a></div></td>
								</tr>
								</table>
								</form>
                </div>
                </div>