<!--CallBack-->                    
<div id="stf_win">
           <div style="float: left; padding: 3px 10px;width: 290px;height: 254px;background: #fff; border: 1px solid #E2E2E2; border-left: 0px; border-right: 0px;">
              <p style="color: gray; margin: 0;font-weight: bold;">Запишитесь на прием и мы перезвоним вам</p>
               $MFORM_2$    
           </div>
           <div style="float: left;">
               <a href="#" id="stf_win_open">Позвоните мне</a>
           </div>
</div>
<!--#CallBack-->

<style>
#stf_win{
         font: 12px/18px Tahoma, Verdana, sans-serif;
         position: absolute;        
         top: 200px;
         left: -310px;
         line-height: 200%;
         display: inline-block;
}
#stf_win input[type='text'],textarea{
           width: 95%!important;
           font-family: Tahoma, Verdana, Arial, Sans-Serif, Lucida Sans;
           font-size: 14px;
           padding: 5px 5px 5px;
           background: #FFF;
           border-top: 1px solid #ABADB3;
           border-bottom: 1px solid #DCDCDC;
           border-left: 1px solid #DCDCDC;
           border-right: 1px solid #DBDFE6;
           -webkit-border-radius: 2px;
           -moz-border-radius: 2px;
           border-radius: 2px;
}
#stf_win_open{
           background: url(http://demo.ucozon.ru/files/upload/img.png) no-repeat;
           text-indent: -99999px;
           display: block;
           width: 41px;
           height: 262px;
}
</style>

<script>
$(document).ready(function(){        
           $("#stf_win_open").click(function () {
               var th = $("#stf_win");
               if (th.css('left') == '-310px') {
                   th.animate({
                       'left':'0px'
                   },100);
               } else {
                   th.animate({
                       'left':'-310px'
                   },100);
               }
               return false;
           });         
});               
</script>

Имя (*):<br/>
<input type="text" name="f2" size="30"/>
<br/>
Телефон (*):<br/>
<input type="text" name="f4" size="30"/>
<input type="hidden" name="f1" value="hidden@ucoz-mail.com"/>
<br/>
Комментарий:<br/>
<textarea rows="7" name="f3" cols="30" style="overflow: hidden; resize: none; height: 40px;"></textarea>
<br/>
* отмечены обязательные поля <input type="submit" style="float: right;" value="Отправить"/>