gistfile1.txt

:table
  &nbsp;                       | <h3>Find a Doctor Near You by Name or Specialty</h3>
  Doctor Name:                 | <input type="text" size="30" />
  Your Zip Code:               | <input type="text" size="10" />
  Doctors within:              | <select><option>5</option></select>
  Speciality:                  | <select><option>Any Speciality</option></select>
  Gender of Doctor:            | <select><option>No Preference</option></select>
  Additional Languages Spoken: | <select><option>No Language Preference</option></select>
  Show:                        | <label><input type="radio" name="show" />PeaceHealth Medical Group doctors only</label><br /><label><input type="radio" name="show" />All PeaceHealth and affiliated community doctors</label>
  &nbsp;                       | <input type="submit" value="Search" />&nbsp;&nbsp;&nbsp;&nbsp;<a href="">Clear Search</a>