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document.write("<div class='enquete_preview_80228'><div class='alignDiv'><div class='bodyDiv'><form  name='formulaire' action='http://navi.enq1.shinobi.jp/vote/84123/' method='post'><div class='titleDiv'>接骨院ｎａｖｉアンケート</div><div class='questionDiv'>通院しやすい曜日は？</div><div class='answerDiv'>");

document.write("<div class='answerSubDiv'><input type='radio' name='vote' value='517553'>月曜</div>");
document.write("<div class='answerSubDiv'><input type='radio' name='vote' value='517554'>火曜</div>");
document.write("<div class='answerSubDiv'><input type='radio' name='vote' value='517555'>水曜</div>");
document.write("<div class='answerSubDiv'><input type='radio' name='vote' value='517556'>木曜</div>");
document.write("<div class='answerSubDiv'><input type='radio' name='vote' value='517557'>金曜</div>");
document.write("<div class='answerSubDiv'><input type='radio' name='vote' value='539007'>土曜</div>");
document.write("<div class='answerSubDiv'><input type='radio' name='vote' value='539008'>日曜</div>");

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	document.write("<a href='http://navi.enq1.shinobi.jp/enquete_p/84123/'>結果</a>");	document.write("</div>");
document.write("</form></div></div></div></div>");