function validateForm() {

	var gender = document.getElementById("gender").value;
	var month = document.getElementById("dob_MM").value;
	var day = document.getElementById("dob_DD").value;
	var year = document.getElementById("dob_YYYY").value;
	var zip = document.getElementById("zip2").value;
	var smoker = document.getElementById("smoker").value;

	if(document.getElementById("gender").value == "") {
		alert("Please select your gender.");
		document.getElementById("gender").focus();
		return false;
	} else if(document.getElementById("dob_MM").value == "" || isNaN(document.getElementById("dob_MM").value) || month > 13 || month < 1 ) {
		document.getElementById("dob_MM").value = "";
		alert("Please tell us the month in which you were born.");
		document.getElementById("dob_MM").focus();
		return false;
	} else if(document.getElementById("dob_DD").value == "" || isNaN(document.getElementById("dob_DD").value) || day < 1 || day > 32) {
		document.getElementById("dob_DD").value = "";
		alert("Please tell us the day on which you were born.");
		document.getElementById("dob_DD").focus();
		return false;
	} else if(document.getElementById("dob_YYYY").value == "" || isNaN(document.getElementById("dob_YYYY").value) || year > 2008 || year < 1920 || year.length < 4) {
		document.getElementById("dob_YYYY").value = "";
		alert("Please tell us the year in which you were born.");
		document.getElementById("dob_YYYY").focus();
		return false;
	} else if(document.getElementById("zip2").value == "" || isNaN(document.getElementById("zip2").value) || zip == "00000" || zip.length < 5){
		document.getElementById("zip2").value = "";
		alert("Please tell us your zip code.");
		document.getElementById("zip2").focus();
		return false;
	} else if(document.getElementById("smoker").value == "") {
		alert("Please tell us if you are a smoker.");
		document.getElementById("smoker").focus();
		return false
	} else if(!sliderValue()) {
		return false;
	} else {

		var copay = document.getElementById("copayField").value;
		var coins = document.getElementById("coinsField").value;
		var deduct = document.getElementById("deductField").value;

		var copayInc = "&filter_copay="+copay;
		var coinsInc = "&filter_coinsurance="+coins;
		var deductInc = "&filter_deductible="+deduct;

		if(copay == "") {
			copayInc = "";
		}

		if(coins == "") {
			coinsInc = "";	
		}

		if(deduct == "") {
			deductInc = "";	
		}

		document.sliderForm.action = "https://www.gohealthinsurance.com/instant/quote/prepopulation?zip="+zip+"&applicant_gender="+gender+"&applicant_dob="+month+"/"+day+"/"+year+"&applicant_smoker="+smoker+copayInc+coinsInc+deductInc;
		document.sliderForm.submit();
	}

}

function sliderValue() {

	var copayValue = document.getElementById("debug1").innerHTML;
	var coinsValue = document.getElementById("debug2").innerHTML;
	var deductValue = document.getElementById("debug3").innerHTML;
	
	if(copayValue == 0) {
		document.getElementById("copayField").value = "";
	} else if(copayValue == 1) {
		document.getElementById("copayField").value = 10;	
	} else if(copayValue == 2) {
		document.getElementById("copayField").value = 20;	
	} else if(copayValue == 3) {
		document.getElementById("copayField").value = 30;	
	} else if(copayValue == 4) {
		document.getElementById("copayField").value = 40;	
	} else {
		document.getElementById("copayField").value = 50;	
	}
		
	if(coinsValue == 0) {
		document.getElementById("coinsField").value = "";
	} else if(coinsValue == 1) {
		document.getElementById("coinsField").value = 10;	
	} else if(coinsValue == 2) {
		document.getElementById("coinsField").value = 20;	
	} else if(coinsValue == 3) {
		document.getElementById("coinsField").value = 30;	
	} else if(coinsValue == 4) {
		document.getElementById("coinsField").value = 40;	
	} else {
		document.getElementById("coinsField").value = 50;	
	}
	
	if(deductValue == 0) {
		document.getElementById("deductField").value = "";
	} else if(deductValue == 1) {
		document.getElementById("deductField").value = 500;	
	} else if(deductValue == 2) {
		document.getElementById("deductField").value = 1000;	
	} else if(deductValue == 3) {
		document.getElementById("deductField").value = 2000;	
	} else if(deductValue == 4) {
		document.getElementById("deductField").value = 3000;	
	} else {
		document.getElementById("deductField").value = 5000;	
	}

	return true;

}