@font-face{
  font-family: "Dancing Script";
  font-style: normal;
  font-weight: 400;
  src:  local("Dancing Script Regular"),
        local("DancingScript-Regular"),
        url("https://fonts.gstatic.com/s/dancingscript/v8/DK0eTGXiZjN6yA8zAEyM2Ud0sm1ffa_JvZxsF_BEwQk.woff2") format("woff2"),
        url("https://fonts.gstatic.com/s/dancingscript/v8/DK0eTGXiZjN6yA8zAEyM2VhlQWQpSCpzb2Peu3I-Q34.woff") format("woff");
}
@font-face{
  font-family: "Dancing Script";
  font-style: normal;
  font-weight: 700;
  src:  local("Dancing Script Bold"),
        local("DancingScript-Bold"),
        url("https://fonts.gstatic.com/s/dancingscript/v8/KGBfwabt0ZRLA5W1ywjowUHdOuSHeh0r6jGTOGdAKHA.woff2") format("woff2"),
        url("https://fonts.gstatic.com/s/dancingscript/v8/KGBfwabt0ZRLA5W1ywjowfVc48Rxw3pIW-IHeDZiIVI.woff") format("woff");
}
body{
  background: url("../images/kids_bg.jpg") fixed no-repeat bottom center;
  background-size:cover;
  color:#444;
  line-height:1.6;
  font-weight: bold;
}
.form_text_input{
  border-color:#666;

}
.form_text_box{
  display:block;
  clear:both;
  height:53.5px;
  width:98%;
}
.text-danger{
  color: #900000;
}


#form_logo{
  margin: auto;
  display: block;
  z-index: 0;
  postion: relative;
}
input{
  background: transparent;
  box-sizing: border-box;
}
.form_default{
  background: none;
}
.col_50{
  width: 50%;
  float: left;
}
.bold_text{
  font-weight: bold;
  font-size: 120%;
}
.text_center{
  text-align: center;
  width: 100%;
  display: block;
}
.box{
  padding: 5px;
  border-radius:10px;
  box-sizing: border-box;
  z-index: 10;
  position: relative;
}
.box_header{
  border-radius:0 10px 0 0;
  width: 100%;
  color: #fff;
  text-align: center;
  font-size: 120%;
  font-weight: bold;
  margin: -5px -5px 5px;
  padding: 5px;
}
.box_number{
  background: #ffffff;
  font-size: 250%;
  font-weight: bold;
  position: absolute;
  padding: 0 10px;
  border-radius: 20px;
  line-height: 1.2;
  top: -20px;
  left: 0;
}
.box_half{
  width: 48%;
  margin: 25px 1% 0;
  float: left;
}
.box_full{
  width: 98%;
  float: left;
  margin: 20px 1% 0;
}
.box_group_half{
  width: 48%;
  float: left;
  margin: 0 1%;
}
.box_group_half .box_full{
  width: 100%;
  float: left;
  margin: 25px 0 0;
}
.box_full .box_half{
  margin: 0 1%;
}
.yes_no_half {
  width: 48%;
  margin: 0 1%;
  float: left;
}
.box_group_half .box_full.random_box{
  margin: 10px 0 0;
}
.random_box{
  padding: 5px;
  background: #edc370;
  border: 3px solid #563e88;
  box-sizing: border-box;
  margin: 10px 0 0;
}
.top_column_left,.top_column_right{
  width: 50%;
  float: left;
  box-sizing: border-box;
  margin-top: 10px;
}
.top_column_left_content,.top_column_right_content{
  width: 80%;
  margin: auto;
  padding: 0 15px;
  font-size: 14px;
  background-image: url(/patient_forms/images/pham_border.png);
  background-size: cover;
  height: 160px;
  text-align: center;
}
.top_column_left_content p:not(.top_column_left_title){
  margin-top: 0;
  line-height: 1.3;
  font-family: "Dancing Script",cursive,serif,sans-serif;
  font-size: 18px;
  font-weight: bold;
}
.top_column_left_stuff{
  padding: 3px 5px 0;
}
.top_column_right_stuff{
  padding-top: 7px;
}
.top_column_left_title{
  font-family: "Timew New Roman",serif;
  font-size: 40px;
  font-weight: bold;
  color: rgb(236, 231, 203);
  font-style: italic;
  margin-top: 12px;
  margin-bottom: 0;
  line-height: 1;
  text-shadow: -1px -1px 0 #0042b3, 1px -1px 0 #0042b3, -1px 1px 0 #0042b3, 1px 1px 0 #0042b3;
}
.top_column_right_title{
  font-size: 24px;
  font-weight: bold;
  margin-top: 12px;
  margin-bottom: 0;
  line-height: 1;
}
.top_column_right_subtitle{
  font-size: 23px;
  color: rgb(92, 160, 215);
  font-style: italic;
  margin: 27px 0 0;
}
.top_column_right_text{
  margin-top: 0;
}
#top_boxes{
  margin: -50px 0 0 0;
}
#last_name,#first_name,#middle_name{
  display: inline-block;
  font-size: 80%;
  width: 26%;
}
#last_name{
  margin-left: 81px;
}
.street_address{
  font-size: 80%;
  margin: 0 10px 0 130px;
}
.city,.state,.zip{
  font-size: 80%;
  display: inline-block;
}
.marital_status label{
  width: 70px;
  float: left;
}
.marital_status input{
  width: 20px;
  float: left;
}
#general_information .fixed_width{
  width: 250px;
  display: inline-block;
  vertical-align: bottom;
}
#general_information input{
  vertical-align: bottom;
}
.inline_right{
  display: inline-block;
  vertical-align: bottom;
}
.col_33{
  width: 30%;
  margin: 0 1%;
  float: left;
}
#medical_problems_textbox{
  width: 98%;
  height: 75px;
}
.form_patient_name {
    color: red;
    padding: 1em;
    background-color: #fff;
    border-radius: 10px;
}

/* ABOUT YOUR CHILD CUSTOMIZATION */
#about_your_child{
  background-color:#ffdcdc;
}
#about_your_child .box_header{
  background-color:#ff0c0c;
  color:#fff;
}
#about_your_child .box_number{
  box-shadow: #ff0c0c 3px 2px 0px 0px;
  border: 2px solid #ff0c0c;
  color:#ff0c0c;
}
#about_your_child .form_text_input{
  background-color:rgba(255,255,255,.5);
  border-color:#ff0c0c;
}

/* GENERAL INFO CUSTOMIZATION */
#general_info{
  background-color:#d8eeff;
}
#general_info .box_header{
  background-color:#0024ff;
  color:#fff;
}
#general_info .box_number{
  box-shadow: #0024ff 3px 2px 0px 0px;
  border: 2px solid #0024ff;
  color:#0024ff;
}
#general_info .form_text_input{
  background-color:rgba(255,255,255,.5);
  border-color:#0024ff;
}

/* PARENTS INFO CUSTOMIZATION */
#parents_info{
  background-color:#ffefd7;
}
#parents_info .box_header{
  background-color:#ff9c00;
  color:#fff;
}
#parents_info .box_number{
  box-shadow: #ff9c00 3px 2px 0px 0px;
  border: 2px solid #ff9c00;
  color:#ff9c00;
}
#parents_info .form_text_input{
  background-color:rgba(255,255,255,.5);
  border-color:#ff9c00;
}
#mothers_info{
  border-radius:0;
  border-right:1px solid #333;
}
#fathers_info{
  border-radius:0;
  border-left:1px solid #333;
}

/* SIGNATURE RELEASE CUSTOMIZATION */
#signature_release{
  background-color:#f3dcff;
}
#signature_release .box_header{
  background-color:#a800ff;
  color:#fff;
}
#signature_release .box_number{
  box-shadow: #a800ff 3px 2px 0px 0px;
  border: 2px solid #a800ff;
  color:#a800ff;
}
#signature_release .form_text_input{
  background-color:rgba(255,255,255,.5);
  border-color:#a800ff;
}
/* GENERAL INFORMATION CUSTOMIZATION */
#general_information{
  background-color:#cef1ff;
}
#general_information .box_header{
  background-color:#00b4ff;
  color:#fff;
}
#general_information .box_number{
  box-shadow: #00b4ff 3px 2px 0px 0px;
  border: 2px solid #00b4ff;
  color:#00b4ff;
}
#general_information .form_text_box,
#general_information .form_text_input{
  background-color:rgba(255,255,255,.5);
  border-color:#00b4ff;
  color: green;
}

/* MEDICAL HISTORY CUSTOMIZATION */
#medical_history{
  background-color:#fffae1;
}
#medical_history .box_header{
  background-color:#ffd800;
  color:#fff;
}
#medical_history .box_number{
  box-shadow: #ffd800 3px 2px 0px 0px;
  border: 2px solid #ffd800;
  color:#ffd800;
}

/* AUTHORIZATION CUSTOMIZATION */
#authorization{
  background-color:#ffe0f3;
}
#authorization .box_header{
  background-color:#ff00d8;
}
#authorization .box_number{
  box-shadow: #ff00d8 3px 2px 0px 0px;
  border: 2px solid #ff00d8;
  color:#ff00d8;
}
#authorization label{
  display: block;
  margin-bottom:10px;
}
#authorization ul{
  margin: 5px 0;
}
#authorization .form_text_input{
  background-color:rgba(255,255,255,.5);
  border-color:#ff00d8;
}
.form_patient_name {
    color: red;
    padding: 1em;
    background-color: #fff;
    border-radius: 10px;
}
#general_information .fixed_width{
  width: 345px;
  display: inline-block;
}
#medical_history .fixed_width{
  width: 300px;
  display: inline-block;
  padding-left:15px;
}
#medical_history .radio_yes_no{
  margin-left:20px;
}
#general_information input,
#medical_history input{
  vertical-align: middle;
}
.margleftme{margin-left:7px;}
.a4lftrow1{margin-left:7px;}
.a4lftrow2{margin-left:69px;}
.inline_right{
  display: inline-block;
  vertical-align: bottom;
}
.no_chkbx{margin-left:12px;}
.signature{
  float: left;
}
.signature_date{
  float: right;
  margin: 0 75px 0 0;
}
.bottom_grey{
  padding: 5px;
  margin: 5px -5px -5px;
  color: #fff;
  text-align: center;
}
.top_grey{
  width: 100%;
  background-color: #333;
  padding: 5px;
  font-size: 20px;
  text-align: center;
  color: #fff;
  border-radius: 10px 10px 0 0;
  box-sizing: border-box;
}
.bottom_box{
  padding: 5px;
  background: #fff;
}
.bottom_interior_box{
  padding: 5px;
  background: rgb(161, 189, 210);
}
/*INPUT WIDTHS*/
input[name="question_70"]{
  width: 80%;
}
input[name="question_71"],input[name="question_72"],input[name="question_73"]{
  width: 26%;
}
input[name="question_74"],input[name="question_75"],input[name="question_76"]{
  width: 10%;
}
input[name="question_77"]{
  width: 10%;
  margin-right: 5%;
}
input[name="question_80"]{
  width: 10%;
}
input[name="question_81"]{
  width: 65%;
}
input[name="question_82"]{
  width: 67.5%;
}
input[name="question_83"],.city{
  width: 45%;
}
input[name="question_84"],.state{
  width: 30%;
}
input[name="question_85"],.zip{
  width: 22.5%;
}
input[name="question_86"]{
  width: 46%;
}
input[name="question_87"]{
  width: 30%;
}
input[name="question_89"]{
  width: 46%;
}
input[name="question_90"]{
  width: 86.5%;
}
input[name="question_91"]{
  width: 98.5%;
}
input[name="question_92"]{
  width: 75%;
}
input[name="question_93"]{
  width: 78.5%;
}
input[name="question_94"]{
  width: 10%;
}
input[name="question_95"]{
  width: 61%;
}
input[name="question_96"]{
  width: 77%;
}
input[name="question_97"]{
  margin-left: 10px;
}
input[name="question_98"],input[name="question_124"]{
  margin-left: 0;
}
input[name="question_99"],input[name="question_125"]{
  width: 41%;
}
input[name="question_100"],input[name="question_101"],input[name="question_102"],input[name="question_126"],input[name="question_127"],input[name="question_128"]{
  width: 10%;
}
input[name="question_103"],input[name="question_129"]{
  width: 10%;
}
input[name="question_104"],input[name="question_130"]{
  width: 25.5%;
}
input[name="question_105"],input[name="question_160"],input[name="question_131"],input[name="question_163"]{
  width: 97.5%;
}
input[name="question_106"],input[name="question_132"]{
  width: 9%;
}
input[name="question_107"],input[name="question_133"]{
  width: 19%;
}
input[name="question_161"],input[name="question_164"]{
  width: 10%;
}
input[name="question_108"],input[name="question_134"]{
  width: 10%;
}
input[name="question_109"],input[name="question_135"]{
  width: 19%;
}
input[name="question_110"],input[name="question_136"]{
  width: 77%;
}
input[name="question_111"],input[name="question_137"]{
  width: 83.5%;
}
input[name="question_112"],input[name="question_138"]{
  width: 81%;
}
input[name="question_113"],input[name="question_139"]{
  width: 31%;
}
input[name="question_114"],input[name="question_115"],input[name="question_116"],input[name="question_140"],input[name="question_141"],input[name="question_142"]{
  width: 8%;
}
input[name="question_117"],input[name="question_118"],input[name="question_143"],input[name="question_144"]{
  width: 40.75%;
}
input[name="question_119"],input[name="question_145"]{
  width: 78.5%;
}
input[name="question_120"],input[name="question_146"]{
  width: 70%;
}
input[name="question_162"],input[name="question_165"]{
  width: 97.5%;
}
input[name="question_121"],input[name="question_147"]{
  width: 10%;
}
input[name="question_122"],input[name="question_148"]{
  width: 60.5%;
}
input[name="question_123"],input[name="question_149"]{
  width: 52%;
}
input[name="question_150"]{
  width: 81%;
}
input[name="question_3"]{
  width: 80%;
}
input[name="question_6"]{
  width: 49%;
}
input[name="question_11"]{
  width: 73%;
}
input[name="question_12"]{
  width: 10%;
}
input[name="question_13"]{
  width: 20%;
}
input[name="question_14"]{
  width: 28%;
}
input[name="question_55"]{
  width: 80%;
}
#office_use_only{
  margin-top: 5px;
}
.submit_button{
  font-size: 23px;
  background: #006d80;
  color: #fff;
  border: 2px solid #004f5d;
  border-radius: 8px;
  width: 100%;
}
.submit_button:hover{
  background: #004f5d;
}
.modal_bg{
  position: fixed;
  top: 0;
  bottom: 0;
  right: 0;
  left: 0;
  z-index: 5000;
  background: rgba(0, 0, 0, 0.8);
}
.modal_content{
  width: 70%;
  left: 15%;
  position: fixed;
  top: calc(50% - 224px);
  background: #eee;
  padding: 10px;
  text-align: center;
  font-size: 30px;
  border-radius: 10px;
}
.modal_close{
  position: fixed;
  top: 3%;
  right: 3%;
  font-size: 35px;
  color: #fff;
  border: 1px solid #fff;
  padding: 0 13px;
}
.modal_close:hover{
  background: rgba(255, 255, 255, 0.5);
  cursor: pointer;
}
@media print {
  body {background:none;line-height:1.5;}
  #page_break {
    width: 100%;
    margin: 0;
    clear: both;
    height: 1px;
  }
  .top_column_left_content, .top_column_right_content{
    background-image: none;
  }
  .page_break{
    page-break-after: always;
  }
  .box{background-color:#fff !important;margin:0 !important;}
  .box_header{background-color:#fff !important;color:red !important;margin:0 !important}
  .form_text_box,.form_text_input{border-color:#000 !important;}
  .bottom_interior_box{background-color:#fff;padding:0;}
}