头部表单
<form id="article" method="post" onsubmit="return false">
    <input type="hidden" name="country" value="melay">
    <input type="hidden" name="first_url" id="first_url">
	<input type="hidden" name="referer" value="测试中文"/>
    姓名*：<input type="text" value="" name="name"><br/>
	电话*：<input type="text" value="" name="phone"><br/>
	邮箱: <input type="text" name="email"/>
	性别:<input type="radio" name="sex" value="男"><input type="radio" name="sex" value="女">
	年龄:<input type="text" name="age"/>
	地址:<input type="text" name="address"/>
	与患者关系:<input type="text" name="relation"/>
	详情描述:<textarea name="description"></textarea>
    病种类型*：<select name="diseases">
    <option value="">请选择</option>
    <option value="Breast Cancer">乳腺癌</option>
    <option value="Lung Cancer">肺癌</option>
    <option value="Nasopharyngeal Cancer">鼻咽癌</option>
    <option value="Colorectal Cancer">大肠癌</option>
    <option value="Liver Cancer">肝癌</option>
    <option value="Pancreatic Cancer">胰腺癌</option>
    <option value="Bone Cancer">骨癌</option>
    <option value="Kidney Cancer">肾癌</option>
    <option value="Esophageal Cancer">食道癌</option>
    <option value="Lymphoma">淋巴瘤</option>
    <option value="Cervical Cancer">宫颈癌</option>
    <option value="Leukemia">白血病</option>
    <option value="StomachCancer">胃癌</option>
    <option value="Oral Cancer">口腔癌</option>
    <option value="Ovarian Cancer">卵巢癌</option>
    <option value="Prostate Cancer">前列腺癌</option>
    <option value="Brain Cancer">脑癌</option>
    <option value="Skin Cancer">皮肤癌</option>
    <option value="Thyroid Cancer">甲状腺癌</option>
    <option value="Tongue Cancer">舌癌</option>
    <option value="Vaginal Cancer">阴道癌</option>
    <option value="Testicular Cancer">睾丸癌</option>
    <option value="Anal Cancer">肛门癌</option>
    <option value="Adrenal Cancer">肾上腺癌</option>
    <option value="Endometrial Cancer">子宫内膜癌</option>
    <option value="Bladder Cancer">膀胱癌</option>
    <option value="Laryngeal Cancer">喉癌</option>
    <option value="Eye Cancer">眼癌</option>
    <option value="Penile Cancer">阴茎癌</option>
    <option value="Gallbladder Cancer">胆囊癌</option>
    <option value="Multiple Myeloma">多发性骨髓瘤</option>
    <option value="Soft Tissue Cancer">软组织癌</option>
    <option value="Duodenal Cancer">十二指肠癌</option>
    <option value="Bile Duct Cancer">胆道癌</option>
    <option value="Colon Cancer">结肠癌</option>
</select><br/>
</div>
</label>
    <input type="button" value="提交" id="btn">
</form>
<script type="text/javascript" src="https://www.moderncancerhospital.com.my/templets/new/js/jquery-1.11.3.min.js"></script>
<script type="text/javascript">

//设置cookie
 function setCookie(name, value, day) {
	 var oDate = new Date();
	 oDate.setDate(oDate.getDate() + day);
	 document.cookie = name + '=' + value + ';expires=' + oDate + ';path=/';
 }
 //删除cookie
 function delCookie(name) {
 	setCookie(name, 1, -1);
 }
 
 //获取cookie
function getCookie(cname){
  var name = cname + "=";
  var ca = document.cookie.split(';');
  for(var i=0; i<ca.length; i++) 
  {
    var c = ca[i].trim();
    if (c.indexOf(name)==0) return c.substring(name.length,c.length);
  }
  return "";
}

//获取着陆页
if (getCookie('getFirstUrl') == '') {
	var firstUrl = window.location.href;
	if (firstUrl == '') {
		firstUrl = document.URL;
	}
	setCookie('getFirstUrl',firstUrl,7);
}
console.log('first url is :' + getCookie('getFirstUrl'));



	$('#first_url').val(getCookie('getFirstUrl'));
	$('#btn').click(function(){
    	$(this).attr("disabled",true);
    	$(this).css('cursor','not-allowed');
    	$(this).text('Sedang memproses...');
	    $.ajax({
		    type: "POST",
		    url:"https://email.huzheqian.cn/Form.php",
		    data: $("#article").serialize(),
		    success: function(data) {
		        var res = JSON.parse(data);
		        if (res.code == 400) {
		    		alert(res.message);
		    	}else if(res.code == 200){					
					location.href="../../thank-you";
    
		    	}
		        $("#btn").attr("disabled",false);
    			$('#btn').css('cursor','pointer');
		        $('#btn').text('Selesai');
		    }
		});
    })
</script>