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document.write('-->\n');
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document.write('<table class="vote21875" onClick="VOTECHECK_disabledButton(21875, false);"><tr><td>\n');
document.write('<span class="votetitle21875">摂食障害になったことがありますか</span>\n');
document.write('&nbsp;<span class="votedesc21875">チューイング症の方は「その他」を選び、手入力で「チューイング症」とお書きください。</span>\n');
document.write('\n');
document.write('<form name="vform21875" id="vform21875" class="vote21875" action="http://blog.with2.net/vote/" method="post" onSubmit="return VOTECHECK_checkForm(21875);" >\n');
document.write('<input type="hidden" name="m" value="a">\n');
document.write('<input type="hidden" name="id" value="21875">\n');
document.write('<input type="hidden" name="sid" value="726631">\n');
document.write('<input type="hidden" name="char" value="文字">\n');
document.write('<ul class="votechoice21875"><li\n');
document.write('><input type="radio" name="qid" value="0" id="q218750" \n');
document.write('><label for="q218750"\n');
document.write('>いいえ</label><br><li\n');
document.write('><input type="radio" name="qid" value="8" id="q218758" \n');
document.write('><label for="q218758"\n');
document.write('>わからないが１歩手前だと思う</label><br><li\n');
document.write('><input type="radio" name="qid" value="1" id="q218751" \n');
document.write('><label for="q218751"\n');
document.write('>拒食症です</label><br><li\n');
document.write('><input type="radio" name="qid" value="2" id="q218752" \n');
document.write('><label for="q218752"\n');
document.write('>吐かない過食症です</label><br><li\n');
document.write('><input type="radio" name="qid" value="3" id="q218753" \n');
document.write('><label for="q218753"\n');
document.write('>過食嘔吐です</label><br><li\n');
document.write('><input type="radio" name="qid" value="4" id="q218754" \n');
document.write('><label for="q218754"\n');
document.write('>運動依存です</label><br><li\n');
document.write('><input type="radio" name="qid" value="5" id="q218755" \n');
document.write('><label for="q218755"\n');
document.write('>健康食依存です</label><br><li\n');
document.write('><input type="radio" name="qid" value="6" id="q218756" \n');
document.write('><label for="q218756"\n');
document.write('>太るのが怖くて下剤がやめられません</label><br><li\n');
document.write('><input type="radio" name="qid" value="7" id="q218757" \n');
document.write('><label for="q218757"\n');
document.write('>その他</label><br></ul>\n');
document.write('<br>\n');
document.write('コメント：<BR><input type="text" name="msg" class="vcomment21875" size="26" value=""><br>\n');
document.write('<br>\n');
document.write('<select name=sex id="vsex21875"><option value="">性別<option value="1">男性<option value="2">女性</select>\n');
document.write('<select name=age><option value="">年齢<option value="1">10未満<option value="2">10歳代<option value="3">20歳代<option value="4">30歳代<option value="5">40歳代<option value="6">50歳代<option value="7">60歳代<option value="8">70歳代<option value="9">80歳代<option value="10">90歳代<option value="11">100以上</select>\n');
document.write('<br>\n');
document.write('<select name=area><option value="">地域<option value="1">北海道<option value="2">青森<option value="3">岩手<option value="4">秋田<option value="5">宮城<option value="6">山形<option value="7">福島<option value="8">新潟<option value="9">栃木<option value="10">茨城<option value="11">群馬<option value="12">埼玉<option value="13">東京<option value="14">千葉<option value="15">神奈川<option value="16">山梨<option value="17">静岡<option value="18">長野<option value="19">富山<option value="20">岐阜<option value="21">愛知<option value="22">石川<option value="23">福井<option value="24">滋賀<option value="25">三重<option value="26">京都<option value="27">奈良<option value="28">大阪<option value="29">和歌山<option value="30">兵庫<option value="31">鳥取<option value="32">岡山<option value="33">島根<option value="34">広島<option value="35">山口<option value="36">香川<option value="37">徳島<option value="38">高知<option value="39">愛媛<option value="40">福岡<option value="41">佐賀<option value="42">大分<option value="43">長崎<option value="44">熊本<option value="45">宮崎<option value="46">鹿児島<option value="47">沖縄<option value="99">【海外】</select>\n');
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document.write('<input id="vf-btn-21875-1" type="submit" value="投票" onClick="VOTECHECK_setSubmit(21875);" >\n');
document.write(' <input id="vf-btn-21875-2" type="submit" name="cancel" value="結果" onClick="VOTECHECK_setCancel(21875);">\n');
document.write('<input type="hidden" name="cancelb" value="0">\n');
document.write('<input type="hidden" name="done" value="">\n');
document.write('</form>\n');
document.write('<div class="votesite21875">&copy;<a target="_blank" href="http://blog.with2.net/out.php?726631;http%3A%2F%2Fameblo.jp%2Fstep-aya%2F">燃焼系ボディは食べて作る！摂食障害も克服</a></div>\n');
document.write('</td>\n');
document.write('</tr>\n');
document.write('</table><scr' + 'ipt language="javascript" type="text/javascript">\n');
document.write('<!--\n');
document.write('\n');
document.write('var VOTECHECK_cancel = false;\n');
document.write('var vote_submit = false;\n');
document.write('function VOTECHECK_getName(id) {\n');
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document.write('function VOTECHECK_setCancel(id) {\n');
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document.write('function VOTECHECK_checkForm(id) {\n');
document.write('	vote_submit = true;\n');
document.write('	var fm = VOTECHECK_getForm(id);\n');
document.write('	var cnt = document.getElementsByName( VOTECHECK_getName(id) ).length;\n');
document.write('	if( VOTECHECK_cancel ){\n');
document.write('		VOTECHECK_disabledButton(id, true);\n');
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document.write('		alert("項目が選択されていません。");\n');
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document.write('		return false;\n');
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document.write('		alert("コメントは50文字以内で入力してください。");\n');
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document.write('		if( sel[i].checked ){\n');
document.write('			flg = true;\n');
document.write('			break;\n');
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document.write('	return flg;\n');
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document.write('\n');
document.write('// default settings\n');
document.write('function VOTECHECK_loadDefaultValue(id) {\n');
document.write('\n');
document.write('	var fm = VOTECHECK_getForm(id);\n');
document.write('	//var ck = VOTECHECK_loadVoteCookies();\n');
document.write('\n');
document.write('	if( ! fm.sex ){\n');
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document.write('\n');
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document.write('			break;\n');
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document.write('	}\n');
document.write('\n');
document.write('}\n');
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document.write('				break;\n');
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document.write('\n');
document.write('	return ck;\n');
document.write('}\n');
document.write('VOTECHECK_loadDefaultValue(21875);\n');
document.write('//-->\n');
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