body {
	font: 12px Arial, Helvetica, sans-serif;
	color: #000;
	background: #FFF;
	text-align: center;
}
a {
	color: #36689A;
}
h1,
h2,
h3,
h4,
h5 {
}
h2 {
	font-size: 2em;
	padding: 1.5em 0 .3em;
}
.clear {
	clear: both;
}
img {
	max-width: 100%;
}

/* HEADER */
.header h1,
.header h2 {
	display: block;
	margin: 0;
	padding: 0;
}
	.header h1 img {
		height: 70px !important;
	}

/* FORMS */
input[type=text],
input[type=url],
input[type=email],
input[type=tel],
input[type=number],
input[type=password],
textarea {
	border: none;
	background: #EFEFEF;
	width: 100%;
	padding: .3em;
	-webkit-box-sizing: border-box;
	-moz-box-sizing: border-box;
	box-sizing: border-box;
	-webkit-box-shadow: inset 1px 1px 5px rgba(0, 0, 0, 0.2);
	-moz-box-shadow:    inset 1px 1px 5px rgba(0, 0, 0, 0.2);
	box-shadow:         inset 1px 1px 5px rgba(0, 0, 0, 0.2);
}
	input[type=text].mini-text-box {
		width: 3em;
	}
input[type="submit"] {
	text-align: center;
	width: auto;
	margin: 1.625em auto;
	padding: .6em 1em;
	background: #36689A;
	color: #FFF;
	cursor: pointer;
	font-size: 1.2em;
	font-weight: bold;
	box-shadow: 0px 1px 3px rgba(0,0,0,0.3);
	-moz-box-shadow: 0px 1px 3px rgba(0,0,0,0.3);
	-webkit-box-shadow: 0px 1px 3px rgba(0,0,0,0.3);
	border: none;
	border-radius: .4062em;
	-moz-border-radius: .4062em;
	-webkit-border-radius: .4062em;
}
	input[type="submit"]:hover {
		background: #EEE;
		color: #36689A;
	}

label {
	display: block;
	width: 100%;
	-webkit-box-sizing: border-box;
	-moz-box-sizing: border-box;
	box-sizing: border-box;
}
	label.radio-label,
	label.checkbox-label {
		display: inline-block;
		width: auto;
		white-space: pre-wrap;
	}
	.checkbox1-3,
	.checkbox1-2,
	.radio1-3,
	.radio1-2 {
		display: inline-block;
		white-space: nowrap;
		padding: 0 1.2em 1em 0;
	}
	.auto-h {
		height: auto;
	}
		.auto-h label {
			white-space: normal;
		}
	.required,
	.required label {
		color: #d10000;
	}
.required-agreement {
	display: block;
	padding: 1em .3em;
	margin: 1em 0;
	background: #ffd8d8;
}
.canvas_o {
	max-width: 100%;
	border: 1px inset #EEE;
	border-radius: 5px;
	-webkit-border-radius: 5px;
	-moz-border-radius: 5px;
	-webkit-box-shadow: inset 1px 1px 5px rgba(0, 0, 0, 0.2);
	-moz-box-shadow:    inset 1px 1px 5px rgba(0, 0, 0, 0.2);
	box-shadow:         inset 1px 1px 5px rgba(0, 0, 0, 0.2);
}
.help-text {
	color: #999;
	font-size: .9em;
}
.policy-text {
	height: 100px;
	overflow: scroll;
	padding: .5em 1em;
	border-radius: 5px;
	-webkit-border-radius: 5px;
	-moz-border-radius: 5px;
	-webkit-box-shadow: inset 1px 1px 5px rgba(0, 0, 0, 0.2);
	-moz-box-shadow:    inset 1px 1px 5px rgba(0, 0, 0, 0.2);
	box-shadow:         inset 1px 1px 5px rgba(0, 0, 0, 0.2);
	background: #FAFAFA;
}
.submitted-entry {
	font-weight: bold;
}


/* LAYOUT */
.patient-form-container {
	margin: 2em auto;
	padding: 0 .5em;
	text-align: left;
	max-width: 1000px;
	position: relative;
	-webkit-box-sizing: border-box;
	-moz-box-sizing: border-box;
	box-sizing: border-box;
}
.patient-form-section {
	border: solid 1px #FFF;
	-webkit-box-sizing: border-box;
	-moz-box-sizing: border-box;
	box-sizing: border-box;
	width: 100%;
}
		.patient-form-section:after {
			content: ".";
			display: block;
			clear: both;
			visibility: hidden;
			line-height: 0;
			height: 0;
		}
		.patient-form-section {
			display: inline-block;
		}
		html[xmlns] .patient-form-section {
			display: block;
		}
		* html .patient-form-section {
			height: 1%;
		}
	.patient-form-section p.section-title {
		clear: both;
		padding: 3em .3em .3em;
		margin: 0;
		font-size: 1.3em;
		text-transform: uppercase;
		font-weight: bold;
		border-top: solid 2px #CCC;
	}
	.patient-form-section p.sub-title {
		clear: both;
		padding: 1em .3em 1em;
		margin: 0;
		font-style: italic;
	}
	
.patient-intake-form {
	margin: 0;
	padding: 0;
}
.submit-container {
	text-align: center;
}

.box1-1,
.box1-2,
.box1-3,
.box2-3,
.box1-4,
.box3-4,
.box1-5,
.box1-8 {
	padding: .3em;
	-webkit-box-sizing: border-box;
	-moz-box-sizing: border-box;
	box-sizing: border-box;
	position: relative
}
.col1-2 {
	-webkit-box-sizing: border-box;
	-moz-box-sizing: border-box;
	box-sizing: border-box;
	position: relative
}

.alt {
	background: #DDD;
}
.patient-form-section.medicare-only {
	background: #f7f4e1;
}

	.alt input[type=text],
	.alt input[type=url],
	.alt input[type=email],
	.alt input[type=tel],
	.alt input[type=number],
	.alt input[type=password],
	.alt textarea {
		/* background: #FFF; */
	}





@media screen and (min-width: 480px) {
	/* HEADER */
	.header {
		width: 100%;
	}
		.header:after {
			content: ".";
			display: block;
			clear: both;
			visibility: hidden;
			line-height: 0;
			height: 0;
		}
		.header {
			display: inline-block;
		}
		html[xmlns] .header {
			display: block;
		}
		* html .header {
			height: 1%;
		}
	.header h1 {
		text-align: left;
		float: left;
		width: 70%;
	}
	.header h2 {
		text-align: right;
		float: right;
		width: 30%;
	}

	/* FORMS */
	label {
		white-space:nowrap;
		overflow:hidden;
	}

	/* LAYOUT */
	.patient-form-container {
		padding: 0 2em;
	}
	.patient-form-section {
		border-bottom: none;
	}
		.patient-form-section p.section-title {
			border-bottom: solid 1px #FFF;
		}
		.patient-form-section p.sub-title {
			border-bottom: solid 1px #FFF;
		}

	.box1-1,
	.box1-2,
	.box1-3,
	.box2-3,
	.box1-4,
	.box3-4,
	.box1-5,
	.box1-8 {
		float: left;
		border-right: solid 1px #FFF;
		border-bottom: solid 1px #FFF;
		min-height: 4em;
	}
		.clearfix,
		.first {
		    clear:both;
		}

	.col1-2 {
		float: left;
	}
		.col1-2:after {
			content: ".";
			display: block;
			clear: both;
			visibility: hidden;
			line-height: 0;
			height: 0;
		}
		.col1-2 {
			display: inline-block;
		}
		html[xmlns] .col1-2 {
			display: block;
		}
		* html .col1-2 {
			height: 1%;
		}
	.box1-1,
	.last {
		border-right: none;
	}
	.box1-1 {
		width: 100%;
	}
	.box1-2,
	.col1-2 {
		width: 50%;
	}
	.box1-3 {
		width: 33%;
	}
		.box1-3.last {
			width: 34%;
		}
	.box2-3 {
		width: 66%;
	}
		.box2-3.last {
			width: 67%;
		}
	.box1-4 {
		width: 25%;
	}
		.box3-4 {
			width: 75%;
		}
	.box1-5 {
		width: 20%;
	}
	.box1-8 {
		width: 12.5%;
	}
	.auto-h {
		height: auto;
	}
		.auto-h label {
			white-space: normal;
		}

	.check-columns .checkbox1-3,
	.radio-columns .radio1-3 {
		-webkit-box-sizing: border-box;
		-moz-box-sizing: border-box;
		box-sizing: border-box;
		float: left;
		width: 33%;
		white-space: normal;
		padding: 0 .5em 1em;
	}
	.check-columns .checkbox1-2,
	.radio-columns .radio1-2 {
		-webkit-box-sizing: border-box;
		-moz-box-sizing: border-box;
		box-sizing: border-box;
		float: left;
		width: 50%;
		white-space: normal;
		padding: 0 .5em 1em;
	}
}


/* SECUREFORM DEFAULT CSS */

/* Do not edit the contents of this block, it will */
/* be auto-regenerated each time you update your form */

body {
	padding: 10px;
	margin: 0;
	background-color: #FFFFFF;
	color: #333333;
   font-size: 13px;
	font-family: Arial, Helvetica, sans-serif;
	line-height: 1.5em;
	}

td, th, p, li, blockquote, a, dt, dd {
	color: #333333;
   font-size: 13px;
	font-family: Arial, Helvetica, sans-serif;
	line-height: 1.5em;
	}

h1,h2,h3,h4,h5,h6,h7 {
	color: #333333;
	font-family: Arial, Helvetica, sans-serif;
	font-weight: bold;
	}

input, select, textarea {
	font-family: Arial, Helvetica, sans-serif;
   font-size: 13px;
	}

.x_getgeo {
   border: 1px solid #CCC;
   background-color: #EEE;
   border-radius:5px;
   padding:2px;
   }	
/* SECUREFORM DEFAULT CSS */