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document.write('<table cellspacing="2" style="border: 1px solid Black">');
document.write('  <tr>');
document.write('    <td nowrap><font color="Black" face="Arial" size="1"><b>Grund eurer Kinderlosigkeit?<br />');
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document.write('(nur eine Antwort möglich)</b></font></td>');
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document.write('  <tr>');
document.write('    <td nowrap><font color="Black" face="Arial" size="1">');
document.write('      <input type="radio" name="vote" value="0">');
document.write('      wir haben keine Probleme<br>');
document.write('      <input type="radio" name="vote" value="1">');
document.write('      ich bin schwanger!<br>');
document.write('      <input type="radio" name="vote" value="2">');
document.write('      wir probieren es noch nicht lange<br>');
document.write('      <input type="radio" name="vote" value="3">');
document.write('      wurde noch nicht untersucht<br>');
document.write('      <input type="radio" name="vote" value="4">');
document.write('      mein Mann wurde nicht untersucht<br>');
document.write('      <input type="radio" name="vote" value="5">');
document.write('      ich wurde nicht untersucht<br>');
document.write('      <input type="radio" name="vote" value="6">');
document.write('      bei uns beiden wurde nichts gefunden<br>');
document.write('      <input type="radio" name="vote" value="7">');
document.write('      unbekannt<br>');
document.write('      <input type="radio" name="vote" value="8">');
document.write('      schlechte Spermienqualität<br>');
document.write('      <input type="radio" name="vote" value="9">');
document.write('      Samenleiterverschluß<br>');
document.write('      <input type="radio" name="vote" value="10">');
document.write('      Spermienantikörper<br>');
document.write('      <input type="radio" name="vote" value="11">');
document.write('      postcoital Test schlecht<br>');
document.write('      <input type="radio" name="vote" value="12">');
document.write('      Gelbkörperschwäche<br>');
document.write('      <input type="radio" name="vote" value="13">');
document.write('      Prolaktin erhöht<br>');
document.write('      <input type="radio" name="vote" value="14">');
document.write('      männliche Hormone erhöht<br>');
document.write('      <input type="radio" name="vote" value="15">');
document.write('      Schilddrüsenfehlfunktion<br>');
document.write('      <input type="radio" name="vote" value="16">');
document.write('      PCOS<br>');
document.write('      <input type="radio" name="vote" value="17">');
document.write('      Endometriose<br>');
document.write('      <input type="radio" name="vote" value="18">');
document.write('      Fehlgeburten<br>');
document.write('      <input type="radio" name="vote" value="19">');
document.write('      Kein Eisprung<br>');
document.write('      <input type="radio" name="vote" value="20">');
document.write('      zu wenig Progesteron<br>');
document.write('      <input type="radio" name="vote" value="21">');
document.write('      verschlossene Eileiter<br>');
document.write('      <input type="radio" name="vote" value="22">');
document.write('      Myome<br>');
document.write('      <input type="radio" name="vote" value="23">');
document.write('      Sonstiges');
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document.write('  </tr>');
document.write('  <tr>');
document.write('    <td><font color="Black" face="Arial" size="1">');
document.write('      <input type="submit" name="submit" value="Abstimmen">');
document.write('      <a href="http://114513.vote.onetwomax.de/?view=result">Ergebnis</a></font>');
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document.write('  </tr>');
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document.write('</td></form></tr></table>');
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