function checkForm() {

	var formError = Boolean(false);
	var fieldList = new Array();
	
	if(document.getElementById('First_name').value == "") {
		formError = true;
		fieldList.push("Patient's First Name");
	}
	
	if(document.getElementById('Last_name').value == "") {
		formError = true;
		fieldList.push("Last Name");
	}

	if(document.getElementById('Address').value == "") {
		formError = true;
		fieldList.push("Address");
	}

	if(document.getElementById('City').value == "") {
		formError = true;
		fieldList.push("City");
	}

	if(document.getElementById('State').value == "") {
		formError = true;
		fieldList.push("State");
	}

	if(document.getElementById('Zip').value == "") {
		formError = true;
		fieldList.push("Zip");
	}

	if(document.getElementById('Contact_Name').value == "") {
		formError = true;
		fieldList.push("Contact Name");
	}

	if(document.getElementById('Contact_Phone').value == "") {
		formError = true;
		fieldList.push("Contact Phone");
	}

	if(document.getElementById('Email_Address').value == "") {
		formError = true;
		fieldList.push("E-mail Address");
	}

	var accountBalance = document.getElementById('Account_Balance').checked;
	var balanceQuestion = document.getElementById('Balance_Question').checked;
	var itemizationRequest = document.getElementById('Itemization_Request').checked;
	var other = document.getElementById('Other').checked;
	if(!accountBalance && !balanceQuestion && !itemizationRequest && !other) {
		formError = true;
		fieldList.push("Type of Assistance Needed");
	}
	
	if(document.getElementById('SSN').value == "") {
		formError = true;
		fieldList.push("Account # or SSN");
	}

	if(document.getElementById('Service_Date').value == "") {
		formError = true;
		fieldList.push("Date of Service");
	}
	
	var hospital = document.getElementById('Hospital').checked;
	var physician = document.getElementById('Physician').checked;
	var ambulance = document.getElementById('Ambulance').checked;
	if(!hospital && !physician && !ambulance) {
		formError = true;
		fieldList.push("Type of Bill");
	}
	
	if(document.getElementById('Reason').value == "") {
		formError = true;
		fieldList.push("Reason for inquiry");
	}
	
	if(formError) {
		alert("Please check the listed fields, and try again:\n\n" + fieldList.join("\n"));
		return false;
	} else {
		return true;
	}
	
}