section.insurance-order-form{position:relative;overflow:hidden}.insurance-order-form-container{max-width:1200px;margin:0 auto;padding:3rem;background-color:#e1e1e1}.progress-bar-component{position:relative;max-width:1200px;height:.5rem;background:#32cd32;overflow:hidden;margin:0 auto}.progress-bar-component-slider{position:absolute;width:100%;height:100%;top:0;left:0;background:#bfbfbf;transform:translate(0)}.form-progress-information-wrapper{max-width:1200px;margin:0 auto;display:flex;justify-content:space-between;padding:0 1rem;height:1px;background:#ffffff4d}.form-progress-information-wrapper div{margin-top:.5rem}.form-title-line h2{font-size:2.5rem;color:var(--primary-color-burgandy)}.form-title-line{position:relative;width:100%;padding-top:2rem}.form-title-line:before{content:"";width:calc(100% + 6rem);height:1px;background-color:#fff;position:absolute;bottom:-.3rem;left:-3rem}.form-title-line.insurance-information:after{content:"";width:calc(100% + 6rem);height:1px;background-color:#fff6;position:absolute;top:-.3rem;left:-3rem}.required-field-entry-visual{position:relative}.required-field-entry-visual:after{content:"*";position:absolute;color:var(--primary-color-burgandy);font-weight:700;font-size:2.5rem;top:-.5rem;left:0}section.pages ul.form-field-entries{list-style:none}.form-field-entries{display:flex;flex-direction:column;gap:1rem;list-style:none}.form-field-entry{display:flex;flex-direction:column;gap:.4rem;width:100%;border-radius:.5rem;padding:.2rem;position:relative}.form-field-entry>label:first-of-type{font-size:1.25rem;font-weight:700;width:fit-content}.same-row-fields{display:flex;gap:1rem;flex-wrap:wrap}.same-row-fields div{width:calc(50% - .5rem)}.same-row-fields.three-fields .city-input-wrapper{width:calc(60% - 1rem)}.same-row-fields.three-fields .state-input-wrapper{width:10%}.same-row-fields.three-fields .zipcode-input-wrapper{width:calc(30% - 1rem)}.same-row-fields.three-fields .state-input-wrapper input[type=text],.date-of-birth-input-container input[type=date]{text-align:center;text-transform:uppercase;padding:0}.field-with-label-name{display:flex;flex-direction:column;width:100%}.field-with-label-name label:last-of-type{padding-top:.2rem;padding-bottom:.5rem;font-size:.8rem}.form-field-entry input[type=text],.form-field-entry input[type=tel],.form-field-entry input[type=date]{height:2.5rem;font-size:1.5rem;border-radius:.4rem;background-color:#fffc;padding-left:.4rem}.form-field-entry input[type=date]{padding-left:0}.date-of-birth-input-container{width:calc(50% - 1rem)}.date-of-birth-input-container input[type=date]{width:100%}.more-information-label{position:relative}button.more-information-btn{position:absolute;transform:translate(0);width:25px;text-align:right;background:none;border:none;cursor:help;font-weight:900;color:var(--primary-color-blue)}button.more-information-btn:first-child{width:12px;text-align:center}.more-information-popup{position:absolute;width:50%;border:1px solid black;padding:.5rem;border-radius:.5rem;z-index:1;background:#4b4b4b;color:#fff;transform:translateY(-100%);box-shadow:0 0 9px 3px #0003;top:0}button.more-info-close-btn{float:right;border-color:#fff;background:none;color:#fff;padding:.25rem;cursor:pointer;font-weight:700;margin-top:.25rem}button.more-info-close-btn:hover{border-color:var(--primary-color-burgandy)}.custom-upload-btn-container{padding:2rem;display:flex;flex-direction:column;justify-content:center;align-items:center;gap:.5rem;border:1px solid var(--primary-color-blue);cursor:pointer;font-size:1.25rem;border-radius:.5rem;box-shadow:0 0 3px 1px #0003;background:#fffc;position:relative}.upload-field-input-container label{display:block;position:relative;width:70%}.text-area-field-input-container{position:relative}.upload-btn-icon-wrapper{height:3rem;color:var(--primary-color-burgandy);opacity:.8}.form-field-entry textarea{width:100%;font-size:1.25rem;padding:.4rem;resize:none}.custom-upload-btn-container:hover .upload-btn-icon-wrapper{opacity:1}.upload-btn-browse{font-weight:900}.upload-btn-drag-n-drop{color:var(--primary-color-blue);font-size:1rem}.custom-upload-btn-container:hover .upload-btn-drag-n-drop{font-weight:700}.upload-description-container{display:flex;align-items:center;gap:.2rem;width:70%;justify-content:space-between;margin-top:.5rem;padding:.5rem;border-radius:.5rem;color:#fff;background:var(--primary-color-blue)}.upload-description-icon-wrapper{height:2rem}.upload-description-wrapper{display:flex;align-items:center;gap:.5rem}.upload-description-wrapper.right-side{gap:1rem}.upload-file-size{position:relative}.upload-file-size:after{content:"";position:absolute;right:-.5rem;top:50%;width:1px;height:200%;background:#fff3;transform:translateY(-50%)}.upload-delete-btn{border:0;background:none;cursor:pointer;color:#fff}.upload-delete-btn:hover{color:var(--primary-color-burgandy)}.upload-error-container{display:flex;justify-content:space-between;align-items:center;width:70%;padding:.5rem;margin-top:.5rem;border-radius:.5rem;background:var(--primary-color-burgandy);color:#fff}.text-line-content p:not(:last-of-type),.more-information-popup p:not(:last-of-type){margin-bottom:.5rem}.error-message-wrapper.right-side{display:flex;align-items:center;gap:1rem}.file-limit-type-wrapper{position:relative}.file-limit-type-wrapper:after{content:"";position:absolute;right:-.5rem;top:50%;width:1px;height:200%;background:#fff3;transform:translateY(-50%)}.close-message-btn{background:none;border:none;color:#fffc;font-size:1.25rem;font-weight:700;line-height:1;padding:.2rem;cursor:pointer}.close-message-btn:hover{color:#fff}.custom-radio-btn-container{border:1px solid black;padding:1rem .5rem;display:flex;flex-direction:column}.custom-radio-title{padding-bottom:1rem}.custom-radio-btn-wrapper input{-webkit-appearance:none;appearance:none}.custom-radio-btn-wrapper label{position:relative}.custom-radio-btn-wrapper{height:2rem;display:flex;align-items:center;margin-left:3rem}.custom-radio-btn-wrapper label:before{content:"";width:1.5rem;height:1.5rem;border-radius:100%;border:2px solid var(--primary-color-blue);position:absolute;top:50%;transform:translateY(-50%);left:-2.5rem;cursor:pointer;box-shadow:0 0 3px 2px #0003}input[type=radio]+label:after{pointer-events:none}input[type=radio]:hover:not(:checked)+label:after{content:"";width:1rem;height:1rem;border-radius:100%;background:var(--primary-color-burgandy);position:absolute;top:50%;transform:translateY(-50%);left:-2.25rem;opacity:.3;cursor:pointer}input[type=radio]:hover:not(:checked)+label:before{box-shadow:0 0 3px 2px #0000004d}input[type=radio]:checked:hover+label:after{opacity:.9}input[type=radio]:checked+label:after{content:"";width:1rem;height:1rem;border-radius:100%;background:var(--primary-color-burgandy);position:absolute;left:-2.25rem;top:50%;transform:translateY(-50%)}input[type=radio]:focus-visible+label:before{outline:1px solid var(--primary-color-burgandy);border-color:var(--primary-color-burgandy);opacity:.8}input[type=radio]:disabled+label:after{filter:grayscale(1)}.custom-checkbox-container{display:flex;flex-direction:column;gap:.5rem}.custom-checkbox-input-wrapper{display:flex;align-items:center}.custom-checkbox-input-wrapper input{-webkit-appearance:none;appearance:none}.custom-checkbox-input-wrapper label{position:relative;margin-left:3rem}.custom-checkbox-input-wrapper label:before{content:"";width:1.5rem;height:1.5rem;color:var(--primary-color-burgandy);border:2px solid var(--primary-color-blue);border-radius:.25rem;position:absolute;left:-2.5rem;top:50%;transform:translateY(-50%);cursor:pointer;opacity:.5;box-shadow:0 0 3px 1px #0003}.custom-checkbox-input-wrapper label:after{content:"";background:url(//goldengatemedicalsupply.com/cdn/shop/files/check-circle-grey.svg?v=4899010122635035727);width:1.5rem;height:1.5rem;border:2px solid var(--primary-color-blue);border-radius:.25rem;position:absolute;left:-2.5rem;top:50%;transform:translateY(-50%);cursor:pointer;opacity:.1}input[type=checkbox]:hover:not(:checked)+label:before{opacity:.8;box-shadow:0 0 3px 1px #0006}input[type=checkbox]:hover:not(:checked)+label:after{opacity:.3;background:url(//goldengatemedicalsupply.com/cdn/shop/files/check-circle-green.svg?v=6081533517443268906)}input[type=checkbox]:checked+label:before{opacity:1}input[type=checkbox]:checked+label:after{opacity:.8;background:url(//goldengatemedicalsupply.com/cdn/shop/files/check-circle-green.svg?v=6081533517443268906)}input[type=checkbox]:checked:hover+label:before{opacity:.5}input[type=checkbox]:checked:hover+label:after{opacity:.6}input[type=checkbox]:focus-visible+label:before{outline:2px solid var(--primary-color-burgandy);opacity:.8}input[type=checkbox]:focus-visible+label:after{opacity:.3;border-color:var(--primary-color-burgandy);background:url(//goldengatemedicalsupply.com/cdn/shop/files/check-circle-green.svg?v=6081533517443268906)}input[type=checkbox]:checked:focus-visible+label:after{opacity:.6}input[type=checkbox]:disabled+label:after{filter:grayscale(1)}.acknowledgement-field-input-container label{font-size:1.1rem}.form-field-entry.submit-btn input[type=submit]{padding:.75rem;cursor:pointer;background:var(--primary-color-blue);color:#fff;font-size:1.25rem;border-radius:.25rem}.form-field-entry.submit-btn input[type=submit]:disabled{filter:grayscale(1)}.form-field-entry.submit-btn input[type=submit]:hover{background:var(--primary-color-burgandy)}.acknowledgement-policy-modal-btn{border:0;background:none;font-size:1.15rem;font-weight:700;color:var(--primary-color-blue);cursor:pointer;text-decoration:underline}.acknowledgement-policy-modal-btn:hover{color:var(--primary-color-burgandy)}.ackowledgement-modal-container{position:fixed;top:50%;left:50%;width:75%;height:75%;transform:translate(-50%,-50%);background:#fff;z-index:5;padding:.25rem 1rem 1rem;border-radius:.5rem;display:flex;flex-direction:column;box-shadow:0 0 10px 2px #0003}.modal-content-wrapper{overflow:auto}button.modal-close-btn{align-self:flex-end;font-size:1.25rem;font-weight:900;color:#0006;line-height:1;background:none;border:none;padding:.5rem;cursor:pointer}button.modal-close-btn:hover{color:#000}h2.policy-modal-title{font-size:2.5rem;color:var(--primary-color-burgandy);font-family:var(--serif);font-weight:700;border-bottom:1px solid rgba(200,200,200,.4);line-height:1;padding-bottom:.4rem}.policy-contact-tiles-container{display:flex;gap:1rem;margin-top:1rem;flex-wrap:wrap}.policy-contact-tile-wrapper{border:1px solid black;padding:.5rem;display:flex;flex-direction:column;justify-content:center;align-items:center;border-radius:.5rem}.ackowledgement-modal-container ol{margin-left:2rem}button.agreement-btn{align-self:flex-end;padding:1rem;margin-top:1rem;cursor:pointer;color:#fff;background:var(--primary-color-burgandy);font-weight:700;border-radius:.25rem}button.agreement-btn:hover{background:var(--primary-color-blue)}@media (max-width: 375px){.upload-description-container{font-size:.8rem}.upload-error-container{font-size:.9rem}}@media (max-width: 500px){.upload-field-input-container label{width:100%}.more-information-popup{width:98%}}@media (max-width: 768px){.insurance-order-form-container{padding:.4rem}.same-row-fields:not(.three-fields){flex-direction:column}.same-row-fields:not(.three-fields) div,.date-of-birth-input-container{width:100%}.same-row-fields.three-fields .city-input-wrapper{width:100%}.same-row-fields.three-fields .state-input-wrapper{width:30%}.same-row-fields.three-fields .zipcode-input-wrapper{width:calc(70% - 1rem)}.custom-upload-btn-container,.upload-description-container,.upload-error-container{width:100%}.more-information-popup{width:89vw}.ackowledgement-modal-container{width:100%;height:100%;border-radius:0}}@media (max-width: 1100px){.insurance-order-form-container{width:100%}}
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