function writeFeedbackForm()
{
  var VarHTML = '';
  var VarHREF = '';
  var VarReAnchorStrip = new RegExp('#.*$')
  
  VarHREF = document.location.href;
  VarHREF = VarHREF.replace(VarReAnchorStrip, '')
  
  
  VarHTML += '<br />\n';
  VarHTML += '<br />\n';
  VarHTML += '<div class="back-to-top"><a title="Back To Top" href="' + VarHREF + '"><img src="images/back_to_top.gif" alt="Back To Top" border="0" height="46" width="116"><br /></a></div>\n';
  VarHTML += '<div class="feedback-module">\n';
  VarHTML += '<div class="title">Feedback: Help us help you</div>\n';
  VarHTML += '<table border="0" cellpadding="0" cellspacing="0" width="100%">	\n';
  VarHTML += '  <form action="http://www.cisco.com/pcgi-bin/fbdash/survey_submit.pl" name="feedback" method="post" target="thanks" onsubmit="return submitForm()"></form>\n';
  VarHTML += '  <tbody>\n';
  VarHTML += '    <tr>\n';
  VarHTML += '      <td>\n';
  VarHTML += '        <div class="text">Please rate this document.</div>\n';
  VarHTML += '      </td>	\n';
  VarHTML += '      <td>\n';
  VarHTML += '        <div class="input">\n';
  VarHTML += '          <span class="radio-margin">Excellent</span>\n';
  VarHTML += '          <input name="scale_711" value="5" type="radio" />\n';
  VarHTML += '          <input name="scale_711" value="4" type="radio" />\n';
  VarHTML += '          <input name="scale_711" value="3" type="radio" />\n';
  VarHTML += '          <input name="scale_711" value="2" type="radio" />\n';
  VarHTML += '          <input name="scale_711" value="1" type="radio" />Poor\n';
  VarHTML += '        </div>\n';
  VarHTML += '      </td>\n';
  VarHTML += '    </tr>\n';
  VarHTML += '    <tr>\n';
  VarHTML += '      <td>\n';
  VarHTML += '        <div class="text">This document solved my problem.</div>\n';
  VarHTML += '      </td>	<td>\n';
  VarHTML += '        <div class="input">\n';
  VarHTML += '          <input name="choice_965" value="2015" type="radio" />Yes\n';
  VarHTML += '          <input name="choice_965" value="2016" type="radio" />No\n';
  VarHTML += '          <input name="choice_965" value="2017" type="radio" />Just Browsing\n';
  VarHTML += '       </div>\n';
  VarHTML += '      </td>\n';
  VarHTML += '    </tr>\n';
  VarHTML += '    <tr>\n';
  VarHTML += '      <td valign="top">\n';
  VarHTML += '        <div class="text">Suggestions for Improvement \n';
  VarHTML += '          <br />\n';
  VarHTML += '          (512 characters)\n';
  VarHTML += '        </div>	\n';
  VarHTML += '      </td>	\n';
  VarHTML += '      <td>\n';
  VarHTML += '        <div class="textarea">\n';
  VarHTML += '          <textarea rows="5" cols="30" class="inputtext" maxlength="512" wrap="virtual" name="text_713"></textarea>\n';
  VarHTML += '        </div></td>\n';
  VarHTML += '    </tr>\n';
  VarHTML += '    <tr>\n';
  VarHTML += '      <td valign="top">\n';
  VarHTML += '        <div class="text">If you want to be contacted about your feedback, please enter your first and last names in the Name field and your email address in the E-Mail field.</div>\n';
  VarHTML += '      </td>	\n';
  VarHTML += '      <td>	\n';
  VarHTML += '        <table border="0" cellpadding="0" cellspacing="0">	\n';
  VarHTML += '          <tbody>\n';
  VarHTML += '            <tr>	 \n';
  VarHTML += '              <td>\n';
  VarHTML += '                <div class="textlabel">Name </div>\n';
  VarHTML += '              </td>	 \n';
  VarHTML += '            </tr>	 \n';
  VarHTML += '            <tr>\n';
  VarHTML += '              <td>\n';
  VarHTML += '                <div class="textbox">\n';
  VarHTML += '                  <input name="name" size="40" type="text" />\n';
  VarHTML += '                </div>\n';
  VarHTML += '              </td>\n';
  VarHTML += '            </tr>	\n';
  VarHTML += '            <tr>\n';
  VarHTML += '              <td>\n';
  VarHTML += '                <div class="texttitle">Email</div>\n';
  VarHTML += '              </td>\n';
  VarHTML += '            </tr>	\n';
  VarHTML += '            <tr>\n';
  VarHTML += '              <td>\n';
  VarHTML += '                <div class="textbox">\n';
  VarHTML += '                  <input name="email" size="40" type="text" />\n';
  VarHTML += '                </div>\n';
  VarHTML += '              </td>\n';
  VarHTML += '            </tr>\n';
  VarHTML += '          </tbody>\n';
  VarHTML += '        </table>\n';
  VarHTML += '      </td>	\n';
  VarHTML += '    </tr>		  \n';
  VarHTML += '    <tr>\n';
  VarHTML += '      <td class="button" colspan="5" align="right" valign="bottom">\n';
  VarHTML += '        <input name="Submit" value="Submit" onclick="validate();" class="content" type="button" />\n';
  VarHTML += '      </td>\n';
  VarHTML += '    </tr>	\n';
  VarHTML += '  </tbody>\n';
  VarHTML += '</table>\n';
  VarHTML += '<input name="doc_title" value=" Cisco ONS 15194 Installation and Configuration Guide - Preface&nbsp; [Cisco ONS 15100 Series] - Cisco Systems" type="hidden" />\n';
  VarHTML += '<input name="doc_url" value=" http://www.cisco.com/en/US/products/hw/optical/ps1991/products_installation_guide_chapter09186a008007c8bf.html" type="hidden" />\n';
  VarHTML += '<input name="referrer_url" value=" " type="hidden"><input name="feedback_type" value="1" type="hidden"><input name="survey_id" value="293" type="hidden" />\n';
  VarHTML += '<input name="email_notification" value="feedback2techdoc" type="hidden"><input name="redirect_url" value="" type="hidden" />\n';
  VarHTML += '<input name="format" value="right" type="hidden"><input name="submitswitch" value="false" type="hidden" />\n';
  VarHTML += '<input name="doc_type" value=" TSD Products Installation Guide Chapter" type="hidden" />\n';
  VarHTML += '<input name="iapath" value=" cisco.com#Products#Cisco Products#Optical Networking#Metro Core#Cisco ONS 15100 Series" type="hidden" />\n';
  VarHTML += '<input name="docid" value=" ccmigration:09186a008007c8bf" type="hidden" />\n';
  VarHTML += '<input name="iocontext" value="IAM" type="hidden" />\n';
  VarHTML += '</div>\n';
  VarHTML += '<br />\n';
  VarHTML += '<br />\n';

  document.write(VarHTML);
}