@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:.9em;}

h2 {

    margin:0;

}

form{

	color:#000000;

	margin: auto;

	width:880px;
        
        border: 10px solid rgba(0, 0, 0, .2);
        
        padding: 10px;
        background: url(images/pink_bg.jpg);
}
input{  background: none;
        
	border:none;

	margin:0;}

input[type="radio"]{
        -webkit-appearance: checkbox;
        
	border:none;

	margin-left:10px;}

input[type="checkbox"]{
        -webkit-appearance: checkbox;
        
	border:none;

	margin-left:10px;}

label{

    float: left;}

input[type=text]{
    
        width: 100%;


	color:#333333;

	font-family:"Courier New", Courier, monospace;
}

input[type=submit]{

	background-color:#999999;

	border:1px solid #666666;

	clear:left;

	color:#ffffff;

	float:right;

	padding:5px;}

	input[type=submit]:hover{

		background-color:#666666;}

        

lu, li {

        margin:0;

        padding:0;}

li {

    list-style-type: none;

    margin-left:-30px;}

.clear {

        clear:both;

        margin:1px 0px 1px 0px;}



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

.bordered {

        border-top: 1px solid black;

        padding:0 0 0 0;}





.under_label{

	color:#333333;

	font-size:12px;

	margin:2px 0px 0px 0px;

	text-transform:uppercase;}



 

#salutation{

	float:left;

	margin:0px 298px 0px 0px;}	

	#salutation input{

		margin:0px 0px 0px 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: 0px 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 {
            background: url(../images/textarea.png);
            border: none;
            line-height: 14px;
            font-family: Arial, Helvetica, Sans-serif;
            padding: 0px;
            width:280px;
            height:29px;
            resize: none;  
            
        }  
.input_textarea_two
        {
            background: url(../images/textarea.png);
            border: none;
            line-height: 14px;
            font-family: Arial, Helvetica, Sans-serif;
            padding: 0px;
            width:414px;
            height:42px;
            resize: none;
        }
        .notes:focus
        {
            outline: none;
        }
.input_textarea_three
        {
            background: url(../images/textarea.png);
            border: none;
            line-height: 14px;
            font-family: Arial, Helvetica, Sans-serif;
            padding: 0px;
            width:191px;
            height:29px;
            resize: none;
            float: right;
        }
        .notes:focus
        {
            outline: none;
        }
        
        .border_bottom {border-bottom: 1px solid black;}
.top_two_col {display: inline-block;width: 185px;margin-right: 20px;}

.multiple_options_column {
width: 50%;
float: left;
}

.section_title_sub {
font-size: 18px;
display: inline;
border-bottom: none;
font-family: arial;
}