@charset "utf-8";

@font-face {
  font-family: rusticanaroman;
  src: url("fonts/rusticana_roman-webfont.eot");
  src:
    url("fonts/rusticana_roman-webfont.eot?#iefix") format("embedded-opentype"),
    url("fonts/rusticana_roman-webfont.woff") format("woff"),
    url("fonts/rusticana_roman-webfont.ttf") format("truetype"),
    url("fonts/rusticana_roman-webfont.svg#rusticanaroman") format("svg");
  font-weight: normal;
  font-style: normal;
}

html,
body {
  padding: 0;
  font-family: Arial, Helvetica, sans-serif;
  font-size: 0.9em;
}

h2 {
  margin: 0;
}

form {
  color: #000;
  margin: auto;
  width: 880px;
  border: 10px solid rgba(0, 0, 0, 0.2);
  padding: 10px;
  background: url("images/pink_bg.jpg");
}

input {
  background: none;
  border: none;
  margin: 0;
}

input[type="radio"] {
  appearance: checkbox;
  border: none;
  margin-left: 10px;
}

label {
  float: left;
}

input[type="text"] {
  width: 100%;
  color: #333;
  font-family: "Courier New", Courier, monospace;
}

input[type="submit"] {
  background-color: #999;
  border: 1px solid #666;
  clear: left;
  color: #fff;
  float: right;
  padding: 5px;
}

input[type="submit"]:hover {
  background-color: #666;
}

ul,
li {
  margin: 0;
  padding: 0;
}

li {
  list-style-type: none;
  margin-left: -30px;
}

.clear {
  clear: both;
  margin: 1px 0;
}

.form_heading {
  color: #732e7e;
  font-family: rusticanaroman;
  font-size: 70px;
  line-height: 70px;
  letter-spacing: 30px;
  text-align: center;
  margin: 0 0 5px;
}

.bordered {
  border-top: 1px solid black;
  padding: 0;
}

.under_label {
  color: #333;
  font-size: 12px;
  margin: 2px 0 0;
  text-transform: uppercase;
}

#salutation {
  float: left;
  margin: 0 298px 0 0;
}

#salutation input {
  margin: 0 0 0 10px;
}

#todays_date {
  width: 395px;
}

#patient_name {
  width: 480px;
}

#social {
  width: 395px;
}

#patient_address,
#patient_minor_address,
#patient_finance_address,
#patient_emergency_address,
#patient_insurance_address {
  width: 480px;
}

#patient_city,
#patient_minor_city,
#patient_finance_city,
#patient_emergency_city,
#patient_insurance_city {
  width: 245px;
}

#patient_state,
#patient_minor_state,
#patient_finance_state,
#patient_emergency_state,
#patient_insurance_state {
  width: 50px;
}

#patient_zip,
#patient_minor_zip,
#patient_finance_zip,
#patient_emergency_zip,
#patient_insurance_zip {
  width: 80px;
}

#patient_date_of_birth {
  width: 480px;
}

#patient_student_age {
  width: 120px;
}

#patient_school {
  width: 265px;
}

#patient_occupation {
  width: 480px;
}

#patient_employer {
  width: 395px;
}

#patient_spouse_name {
  width: 100%;
}

#patient_home_phone,
#patient_minor_home_phone {
  width: 480px;
}

#patient_work_phone,
#patient_minor_work_phone {
  width: 395px;
}

#patient_cell_phone {
  width: 480px;
}

#patient_email_address {
  width: 395px;
}

#patient_guardian {
  width: 100%;
}

#person_financially_responsible {
  width: 100%;
}

#patient_finance_relationship {
  width: 480px;
}

#patient_finance_phone_number {
  width: 395px;
}

#patient_finance_employer {
  width: 480px;
}

#patient_finance_work_phone {
  width: 395px;
}

#patient_family,
#patient_emergency_contact,
#patient_emergency_phone {
  width: 100%;
}

#patient_consent_signature,
#patient_parent_consent_signature,
#patient_finance_signature,
#patient_health_release_signature {
  width: 725px;
}

#patient_consent_date,
#patient_parent_consent_date,
#patient_finance_date,
#patient_health_release_date {
  width: 150px;
}

#patient_insurance_company {
  width: 480px;
}

#patient_insurance_employer {
  width: 395px;
}

#patient_insurance_employee_name {
  width: 480px;
}

#patient_insurance_date_of_birth {
  width: 395px;
}

#patient_insurance_id_number {
  width: 480px;
}

#patient_insurance_group_number {
  width: 395px;
}

#patient_health_release_name {
  width: 100%;
}

span {
  border-bottom: 1px solid black;
  display: block;
  overflow: hidden;
  padding: 0 4px 0 6px;
}

#form_top_wrapper {
}

#top_left {
  border-right: 1px solid black;
  width: 47%;
  padding: 1%;
  float: left;
}

#top_right {
  float: left;
  width: 47%;
  padding: 1%;
}

.clear_floats {
  clear: both;
}

.four_radios div {
  display: inline-block;
  width: 24%;
}

.two_col {
  display: inline-block;
  width: 430px;
}

.phone_col {
  display: inline-block;
  width: 257px;
}

.phone_b_col {
  display: inline-block;
  width: 612px;
}

.small_col {
  display: inline-block;
  width: 90px;
}

.three_sections {
  margin: 0 5px;
  width: 280px;
  display: inline-block;
  border: 0 solid black;
  vertical-align: top;
}

.right_options {
  display: block;
  float: right;
}

.options label {
  float: none;
  font-size: 12px;
  max-width: 280px;
}

.right_options::after {
  content: ".";
  display: block;
  height: 0;
  clear: both;
  visibility: hidden;
}

.options::after {
  content: ".";
  display: block;
  height: 0;
  clear: both;
  visibility: hidden;
}

.section_title {
  font-family: rusticanaroman;
  font-size: 27px;
  color: #732e7e;
}

.input_textarea_old {
  background-image: linear-gradient(left, #e6d5e8 0, transparent 0), linear-gradient(right, #e6d5e8 0, transparent 0), linear-gradient(#e6d5e8 3px, #000 13px, #000 14px, #e6d5e8 14px);
  background-size:
    100% 100%,
    100% 100%,
    100% 14px;
  border: none;
  line-height: 14px;
  font-family: Arial, Helvetica, sans-serif;
  padding: 0;
  width: 280px;
  height: 29px;
  resize: none;
}

.notes:focus {
  outline: none;
}

.input_textarea {
  background: url("../images/textarea.png");
  border: none;
  line-height: 14px;
  font-family: Arial, Helvetica, sans-serif;
  padding: 0;
  width: 280px;
  height: 29px;
  resize: none;
}

.border_bottom {
  border-bottom: 1px solid black;
}

.top_two_col {
  display: inline-block;
  width: 185px;
  margin-right: 20px;
}