document.write("<link href=\"http://services.service-webmaster.fr/sondages/style.php?id_membre=19837&id=3973\" rel=\"stylesheet\" type=\"text/css\" />");
document.write("<form method=\"post\" action=\"http://services.service-webmaster.fr/sondages/vote.php?id_membre=19837&id=3973&choix_multiple=non\" onsubmit=\"window.open('','popup3973', 'width=500,height=400,top='+((screen.height-400)/2)+',  left='+((screen.width-500)/2)+',scrollbars=1,resizable=1'); return true;\" target=\"popup3973\"  name=\"sondage3973\" id=\"sondage3973\">");
document.write("<div align=\"center\">");
document.write("<table border=\"0\" cellpadding=\"3\" cellspacing=\"0\" class=\"tbl\">");
document.write("<tr>");
document.write("<td colspan=\"2\" class=\"titre\">Avez-vous déjà été mécontent(e) d'une aide à domicile ?</td>");
document.write("</tr>");
document.write("<tr>");
document.write("<td width=\"1%\" align=\"center\" class=\"contenu\"><input type=\"radio\" value=\"vote_1\" name=\"choix\" id=\"reponse_1\"></td>");
document.write("<td width=\"99%\" class=\"contenu\"><label for=\"reponse_1\">OUI</label></td>");
document.write("</tr>");
document.write("<tr>");
document.write("<td width=\"1%\" align=\"center\" class=\"contenu\"><input type=\"radio\" value=\"vote_2\" name=\"choix\" id=\"reponse_2\"></td>");
document.write("<td width=\"99%\" class=\"contenu\"><label for=\"reponse_2\">NON</label></td>");
document.write("</tr>");
document.write("<tr>");
document.write("<td width=\"1%\" align=\"center\" class=\"contenu\"><input type=\"radio\" value=\"vote_3\" name=\"choix\" id=\"reponse_3\"></td>");
document.write("<td width=\"99%\" class=\"contenu\"><label for=\"reponse_3\">Je n'ai encore jamais fait appel à une aide à domicile</label></td>");
document.write("</tr>");
document.write("<tr>");
document.write("<td colspan=\"2\" class=\"voter\" align=\"center\"><input type=\"submit\" name=\"Voter\" value=\"Voter\" /></td>");
document.write("</tr>");
document.write("<tr>");
document.write("<td colspan=\"2\" align=\"center\" class=\"bas\">");
document.write("<p align=\"center\"><a class=\"lien\" href=\"#null\" onClick=\"window.open('http://services.service-webmaster.fr/sondages/resultat-19837-3973-html.html','_blank','toolbar=0, location=0, directories=0, status=0, scrollbars=1, resizable=1, copyhistory=0, menuBar=0, width=400, height=300, top='+((screen.height-300)/2)+', left='+((screen.width-400)/2)+'');return(false)\">Voir les r&eacute;sultats</A></p>");
document.write("</td>");
document.write("</tr>");
document.write("</table>");
document.write("</form>");
document.write("</div>");