y acaba...
<tr><td width="230" align="right" valign="middle"><label>Teléfono </label></td><td><input name="telefono" type="text" /> </td></tr>
<tr><td width="230" align="right" valign="middle"><label>Cita previa </label></td><td><input type="radio" name="citaprevia" value="si" id="citaprevia_0" checked="checked"/>
Sí
<input type="radio" name="citaprevia" value="no" id="citaprevia_1" />
No </td></tr>
<tr><td width="230" align="right" valign="middle"><label>Horario </label></td><td><input name="horario" type="text" size="60"/></td></tr>
<tr><td width="230" align="right" valign="middle"><label>Seguro médico </label></td><td><input name="seguromedico" type="text" size="60"/> </td></tr>
<tr><td width="230" align="right" valign="top"><label><strong>Observaciones <br/>médicas </strong></label></td><td>
<textarea name="observamed" cols="45" rows="4"></textarea> </td></tr>
</table>
</fieldset>
<br/>
<fieldset style="padding:10px;">
<legend class="fieldset">Otros datos</legend>
<table width="620" border="0" cellspacing="2" cellpadding="0">
<tr><td width="230" align="right" valign="middle"><label>Contacto </label></td><td><input name="contacto" type="text" size="60"/></td></tr>
<tr><td width="230" align="right" valign="middle"><label>Empresa </label></td><td><input name="empresa" type="text" size="60"/></td></tr>
<tr><td width="230" align="right" valign="middle"><label>CIF </label></td><td><input name="cif" type="text" /></td></tr>
<tr><td width="230" align="right" valign="middle"><label>Dirección </label></td><td><input name="direccadmin" type="text" size="60"/></td></tr>
<tr><td width="230" align="right" valign="middle"><label>Localidad </label></td><td><input name="localidadmin" type="text" size="60"/></td></tr>
<tr><td width="230" align="right" valign="middle"><label>Código Postal </label></td><td><input name="codigopostadmin" type="text" maxlength="5" size="12"/></td></tr>
<tr><td width="230" align="right" valign="middle"><label>Teléfono </label></td><td><input name="telefonadmin" type="text" /></td></tr>
<tr><td width="230" align="right" valign="middle"><label>Fax </label></td><td><input name="fax" type="text" /></td></tr>
<tr><td width="230" align="right" valign="middle"><label>E-mail </label></td><td><input name="email" type="text" /></td></tr>
<tr><td width="230" align="right" valign="middle"><label>Móvil </label></td><td><input name="movil" type="text" /></td></tr>
<tr><td width="230" align="right" valign="middle"><label>Comercial </label></td><td>
<select name="comercial">
<option value="0" selected="selected"> </option>
<option value="a">A</option>
<option value="b">B</option>
<option value="c">C</option>
</select></td></tr> <tr><td width="230" align="right" valign="top"><label><strong>Observaciones <br/>administrativas </strong><br/>
</label></td><td>
<textarea name="observadmin" cols="45" rows="4"></textarea></td></tr>
<tr><td align="right" valign="middle"><label>Forma de Pago </label></td><td>
<select name="formapago">
<option value="0" selected="selected"> </option>
<option value="Talonario">Talonario</option>
<option value="Transferencia">Transferencia</option>
<option value="TPV virtual">TPV virtual</option>
<option value="Efectivo">Efectivo</option>
<option value="Otros">Otros</option>
<option value="No Pagado">No Pagado</option>
</select></td></tr>
<tr>
<td align="right" valign="middle"><label>Número de recibo </label></td><td><input name="recibonum" type="text" /></td></tr>
</table>
</fieldset>
<p style="text-align:center"><input name="envio" type="submit" value="Enviar datos"/></p>
</form>
</div><!-- y aquí termina el formulario -->
</td>
<td width="30" class="ladod"> </td>
</tr>
<tr>
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