:root{--primary-1:#343434;--primary-4:#fafafa;--secondary-1:#c62424;--tertiary-1:#737373;--secondary-2:#000;--tertiary-2:#4b4b4b;--tertiary-3:rgba(21,21,21,0.3);--tertiary-20:rgba(0,0,0,0.2);--bg-grey:#f3f3f3;--bg-dark-blue:#004061;--linear-gradient-1:linear-gradient(41deg,#0063c3 0,#00bce4 100%);--amgen-blue:#0063c3;--actimmune-green:#78be20}
@keyframes fadeInUp{from{opacity:0;transform:translate3d(0,100%,0)}
to{opacity:1;transform:translate3d(0,0,0)}
}
@keyframes fadeUpIn{from{opacity:0;transform:translate3d(0,100%,0)}
to{opacity:1;transform:translate3d(0,0,0)}
}
:root{--primary-color:#0072ce;--danger-color:#dc3545;--success-color:#28a745;--nav-link-color:#000;--font-family:'Roboto',sans-serif;--body-color:#666;--menu-outer-border:#000;--white:#fff;--error-link-text:#03134b;--error-background:#00144f;--copay-button-bg:#db2825;--copay-lookup-result-bg:#2270bf;--cta-card-border:#aeaeae;--btn-bg:#d5d5d5;--btn-bg-hover:#999;--btn-color:#fff;--border-radius:4px;--menu-border-color:var(--body-color);--link-color:#4c4b4b;--link-hover-color:#000;--select-bg:#999;--select-color:#fff;--select-opener-bg:#ccc;--select-opener-color:#666;--select-drop-bg:#b7b7b7;--select-option-color:#fff;--select-option-hover:#919191;--input-border:#ced4da;--input-border-focus:#000;--filter-box-bg:#eee;--form-base-color:#000;--form-primary-color:#0063c3;--form-text-color:#001830;--form-border-color:#a2b1bc;--form-error-color:#f40000;--form-radio-background-color:#b8dcff;--form-radio-label-color:#333;--form-scroller-bg-color:#1c1e210a;--form-input-text-color:#495057;--form-input-color-focus:#80bdff;--input-disabled-bg:#e9ecef;--service-panel-bg:#e7ebee;--copay-card-bg:#f0f8ff;--consent-active-bg:#2cc84d;--consent-bullet-bg:#d3d3d3;--form-btn-disabled-bg:#e9f4ff}
@font-face{font-family:"Poppins-Bold";src:url("https://fonts.amgen.com/s/poppins/v20/Poppins-Bold.woff2") format("woff2"),url("https://fonts.amgen.com/s/poppins/v20/Poppins-Bold.woff") format("woff");font-weight:bold;font-style:normal;font-display:swap}
@font-face{font-family:"Poppins-BlackItalic";src:url("https://fonts.amgen.com/s/poppins/v20/Poppins-BlackItalic.woff2") format("woff2"),url("https://fonts.amgen.com/s/poppins/v20/Poppins-BlackItalic.woff") format("woff");font-weight:900;font-style:italic;font-display:swap}
@font-face{font-family:"Poppins-Black";src:url("https://fonts.amgen.com/s/poppins/v20/Poppins-Black.woff2") format("woff2"),url("https://fonts.amgen.com/s/poppins/v20/Poppins-Black.woff") format("woff");font-weight:900;font-style:normal;font-display:swap}
@font-face{font-family:"Poppins-ExtraBoldItalic";src:url("https://fonts.amgen.com/s/poppins/v20/Poppins-ExtraBoldItalic.woff2") format("woff2"),url("https://fonts.amgen.com/s/poppins/v20/Poppins-ExtraBoldItalic.woff") format("woff");font-weight:bold;font-style:italic;font-display:swap}
@font-face{font-family:"Poppins-ExtraLight";src:url("https://fonts.amgen.com/s/poppins/v20/Poppins-ExtraLight.woff2") format("woff2"),url("https://fonts.amgen.com/s/poppins/v20/Poppins-ExtraLight.woff") format("woff");font-weight:200;font-style:normal;font-display:swap}
@font-face{font-family:"Poppins-BoldItalic";src:url("https://fonts.amgen.com/s/poppins/v20/Poppins-BoldItalic.woff2") format("woff2"),url("https://fonts.amgen.com/s/poppins/v20/Poppins-BoldItalic.woff") format("woff");font-weight:bold;font-style:italic;font-display:swap}
@font-face{font-family:"Poppins-ExtraBold";src:url("https://fonts.amgen.com/s/poppins/v20/Poppins-ExtraBold.woff2") format("woff2"),url("https://fonts.amgen.com/s/poppins/v20/Poppins-ExtraBold.woff") format("woff");font-weight:bold;font-style:normal;font-display:swap}
@font-face{font-family:"Poppins-LightItalic";src:url("https://fonts.amgen.com/s/poppins/v20/Poppins-LightItalic.woff2") format("woff2"),url("https://fonts.amgen.com/s/poppins/v20/Poppins-LightItalic.woff") format("woff");font-weight:300;font-style:italic;font-display:swap}
@font-face{font-family:"Poppins-ExtraLightItalic";src:url("https://fonts.amgen.com/s/poppins/v20/Poppins-ExtraLightItalic.woff2") format("woff2"),url("https://fonts.amgen.com/s/poppins/v20/Poppins-ExtraLightItalic.woff") format("woff");font-weight:200;font-style:italic;font-display:swap}
@font-face{font-family:"Poppins-Light";src:url("https://fonts.amgen.com/s/poppins/v20/Poppins-Light.woff2") format("woff2"),url("https://fonts.amgen.com/s/poppins/v20/Poppins-Light.woff") format("woff");font-weight:300;font-style:normal;font-display:swap}
@font-face{font-family:"Poppins-Italic";src:url("https://fonts.amgen.com/s/poppins/v20/Poppins-Italic.woff2") format("woff2"),url("https://fonts.amgen.com/s/poppins/v20/Poppins-Italic.woff") format("woff");font-weight:normal;font-style:italic;font-display:swap}
@font-face{font-family:"Poppins-Medium";src:url("https://fonts.amgen.com/s/poppins/v20/Poppins-Medium.woff2") format("woff2"),url("https://fonts.amgen.com/s/poppins/v20/Poppins-Medium.woff") format("woff");font-weight:500;font-style:normal;font-display:swap}
@font-face{font-family:"Poppins-MediumItalic";src:url("https://fonts.amgen.com/s/poppins/v20/Poppins-MediumItalic.woff2") format("woff2"),url("https://fonts.amgen.com/s/poppins/v20/Poppins-MediumItalic.woff") format("woff");font-weight:500;font-style:italic;font-display:swap}
@font-face{font-family:"Poppins-Regular";src:url("https://fonts.amgen.com/s/poppins/v20/Poppins-Regular.woff2") format("woff2"),url("https://fonts.amgen.com/s/poppins/v20/Poppins-Regular.woff") format("woff");font-weight:normal;font-style:normal;font-display:swap}
@font-face{font-family:"Poppins-SemiBold";src:url("https://fonts.amgen.com/s/poppins/v20/Poppins-SemiBold.woff2") format("woff2"),url("https://fonts.amgen.com/s/poppins/v20/Poppins-SemiBold.woff") format("woff");font-weight:600;font-style:normal;font-display:swap}
@font-face{font-family:"Poppins-SemiBoldItalic";src:url("https://fonts.amgen.com/s/poppins/v20/Poppins-SemiBoldItalic.woff2") format("woff2"),url("https://fonts.amgen.com/s/poppins/v20/Poppins-SemiBoldItalic.woff") format("woff");font-weight:600;font-style:italic;font-display:swap}
@font-face{font-family:"Poppins-ThinItalic";src:url("https://fonts.amgen.com/s/poppins/v20/Poppins-ThinItalic.woff2") format("woff2"),url("https://fonts.amgen.com/s/poppins/v20/Poppins-ThinItalic.woff") format("woff");font-weight:100;font-style:italic;font-display:swap}
@font-face{font-family:"Poppins-Thin";src:url("https://fonts.amgen.com/s/poppins/v20/Poppins-Thin.woff2") format("woff2"),url("https://fonts.amgen.com/s/poppins/v20/Poppins-Thin.woff") format("woff");font-weight:100;font-style:normal;font-display:swap}
.aemform{width:100%;margin:0 auto;max-width:48.5rem;float:unset !important;margin-top:3rem !important;padding-top:0rem;padding-bottom:0rem}
.aemform .cmp-adaptiveform-radiobutton__widget,.aemform .cmp-adaptiveform-checkboxgroup__widget{color:var(--body-color);flex-wrap:wrap;gap:1.25rem;margin-bottom:.625rem !important;font-size:1rem;display:flex}
.aemform .cmp-adaptiveform-radiobutton__widget.VERTICAL,.aemform .cmp-adaptiveform-checkboxgroup__widget.VERTICAL{flex-direction:column}
.aemform .cmp-adaptiveform-textinput__widget,.aemform .cmp-adaptiveform-emailinput__widget,.aemform .cmp-adaptiveform-telephoneinput__widget,.aemform .cmp-adaptiveform-dropdown__widget{height:2.5rem;margin-top:.5rem !important;font-size:1rem}
.aemform .cmp-adaptiveform-dropdown,.aemform .cmp-adaptiveform-button,.aemform .cmp-adaptiveform-radiobutton,.aemform .cmp-adaptiveform-text,.aemform .cmp-adaptiveform-checkbox,.aemform .cmp-adaptiveform-checkboxgroup{margin-top:.25rem;margin-bottom:.25rem;font-size:1rem}
.aemform .cmp-container{padding:0rem !important;margin:0rem;font-size:1rem}
.aemform .cmp-accordion{margin-top:.25rem;margin-bottom:.25rem}
.aemform form{color:var(--form-text-color);font-family:"Poppins-Regular","Helvetica, Arial, sans-serif";font-size:1rem;font-weight:400;line-height:1.5rem;padding:0rem !important;margin:0rem;visibility:hidden}
.aemform form [class*=error]{font-style:italic;color:var(--form-error-color) !important;margin:0}
.aemform form [class*=error] [class*=cmp-adaptiveform]{color:var(--form-error-color) !important}
.aemform form [id*=error]{font-style:italic;color:var(--form-error-color) !important;margin:0}
.aemform form .dob-validation-error,.aemform form .service-mandatory-check_errormessage{display:none}
.aemform form .cmp-adaptiveform-container__wrapper>.text h2:first-child{color:var(--form-primary-color) !important;font-size:1.75rem;line-height:1.2;font-weight:700;margin-bottom:.5rem !important}
.aemform form .cmp-adaptiveform-container__wrapper>.text h2:first-child+p{font-size:1rem;color:var(--body-color);margin-bottom:1rem !important}
.aemform form .cmp-adaptiveform-text{margin-top:.25rem;margin-bottom:.25rem}
.aemform form .cmp-adaptiveform-text p{margin-bottom:0rem !important}
.aemform form .cmp-adaptiveform-text h5{font-family:"Poppins-Regular","Helvetica, Arial, sans-serif";font-size:1rem;font-weight:700;line-height:1.5rem;margin-bottom:.5rem !important}
.aemform form .cmp-adaptiveform-dropdown__widget{margin-top:0rem;margin-bottom:0rem}
.aemform form .cmp-adaptiveform-radiobutton__widget{min-height:auto !important;gap:1rem}
.aemform form .cmp-adaptiveform-radiobutton__option-label{display:flex;gap:.438rem}
.aemform form .cmp-adaptiveform-radiobutton:has([name*=insuranceType]) .cmp-adaptiveform-radiobutton__widget{gap:1.25rem;flex-wrap:wrap;display:flex;margin-top:1.5rem !important}
@media(max-width:567px){.aemform form .cmp-adaptiveform-radiobutton:has([name*=insuranceType]) .cmp-adaptiveform-radiobutton__widget{display:unset}
}
.aemform form .cmp-adaptiveform-radiobutton:has([name*=insuranceType]) .cmp-adaptiveform-radiobutton__option{padding-top:.125rem !important;padding-bottom:.3125rem !important;padding-left:.125rem !important;padding-right:.3125rem !important;border:1.5px solid var(--form-border-color);width:23.5rem;height:6.5rem;text-align:center;display:flex;flex-direction:column;gap:.313rem;border-radius:.25rem;flex:1 1 45%;cursor:pointer}
@media(max-width:567px){.aemform form .cmp-adaptiveform-radiobutton:has([name*=insuranceType]) .cmp-adaptiveform-radiobutton__option{margin-top:1rem;height:7.875rem;width:100%}
}
@media(min-width:600px){.aemform form .cmp-adaptiveform-radiobutton:has([name*=insuranceType]) .cmp-adaptiveform-radiobutton__option{flex:0 0 48%;min-width:23.5rem;max-width:50%}
}
@media(min-width:768px)and (max-width:992px){.aemform form .cmp-adaptiveform-radiobutton:has([name*=insuranceType]) .cmp-adaptiveform-radiobutton__option{max-width:21.25rem;min-width:48%}
}
.aemform form .cmp-adaptiveform-radiobutton:has([name*=insuranceType]) .cmp-adaptiveform-radiobutton__option:has(input[type=radio]:checked){background-color:var(--form-radio-background-color);border:.094rem solid var(--form-primary-color) !important}
.aemform form .cmp-adaptiveform-radiobutton:has([name*=insuranceType]) .cmp-adaptiveform-radiobutton__option label{height:100%;display:flex;flex-direction:column;gap:.313rem;align-items:unset}
.aemform form .cmp-adaptiveform-radiobutton:has([name*=insuranceType]) .cmp-adaptiveform-radiobutton__option label input{display:none}
.aemform form .cmp-adaptiveform-radiobutton:has([name*=insuranceType]) .cmp-adaptiveform-radiobutton__option label p:first-of-type{color:var(--form-primary-color);font-weight:bold;position:relative}
.aemform form .cmp-adaptiveform-radiobutton:has([name*=insuranceType]) .cmp-adaptiveform-radiobutton__option label>span{height:100%;display:flex;flex-direction:column;gap:.313rem;margin-left:1.3rem !important;margin-top:.3125rem !important;position:relative;text-align:left}
.aemform form .cmp-adaptiveform-radiobutton:has([name*=insuranceType]) .cmp-adaptiveform-radiobutton__option label>span p{margin-bottom:0rem !important;text-align:left}
.aemform form .cmp-adaptiveform-radiobutton:has([name*=insuranceType]) .cmp-adaptiveform-radiobutton__option label>span .tooltip-icon::after{content:"";background-image:url(data:image/svg+xml;base64,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);width:13px;height:13px;background-size:100%;position:absolute;display:block;top:0;right:0}
.aemform form .cmp-adaptiveform-radiobutton:has([name*=insuranceType]) .cmp-adaptiveform-radiobutton__option label>span .tooltip-icon .tooltip-box{display:none}
.aemform form .cmp-adaptiveform-radiobutton:has([name*=insuranceType]) .cmp-adaptiveform-radiobutton__option label>span .tooltip-icon:hover .tooltip-box{display:block;position:absolute;top:-65px;margin-left:0;right:0;margin-bottom:5px;background-color:var(--white);border:2px solid var(--white);border-radius:4px;padding:4px 8px;width:243px;height:56px;z-index:1;font-size:14px;box-shadow:0 2px 6px rgba(0,0,0,.15);text-align:center;color:var(--form-text-color);font-weight:400}
.aemform form .cmp-adaptiveform-radiobutton:has([name*=eligibleForMedicare]){border:.094rem solid var(--form-border-color) !important;padding:.625rem !important}
.aemform form [data-cmp-valid]{padding:0 !important;border:none !important;background:rgba(0,0,0,0) !important}
.aemform form [data-cmp-valid=false] [class*=_label-container] label{color:var(--form-error-color) !important}
.aemform form [data-cmp-valid=false] select,.aemform form [data-cmp-valid=false] input,.aemform form [data-cmp-valid=false] input:after{border-color:var(--form-error-color) !important}
.aemform form [data-cmp-valid=false] .cmp-adaptiveform-radiobutton__option{border-color:var(--form-error-color) !important}
.aemform form [class*=cmp-adaptiveform]:not(.modal [class*=cmp-adaptiveform]){color:var(--form-text-color)}
.aemform form h2,.aemform form .section-heading{font-size:1.5rem;font-weight:700}
.aemform form .back-button button,.aemform form .next-button button{gap:1rem;border:.063rem solid var(--form-primary-color);border-radius:.313rem;color:var(--form-primary-color);background-color:#fff;margin-bottom:1.25rem !important;padding:.938rem 1.563rem;width:7.063rem;height:3.125rem;display:inline-flex;justify-content:center;align-items:center;float:right}
.aemform form .back-button button .cmp-adaptiveform-button__text,.aemform form .next-button button .cmp-adaptiveform-button__text{color:var(--form-primary-color) !important}
.aemform form .back-button button::after,.aemform form .next-button button::after{content:"";display:block;background-image:url(data:image/svg+xml;base64,PHN2ZyB4bWxucz0iaHR0cDovL3d3dy53My5vcmcvMjAwMC9zdmciIHdpZHRoPSI4IiBoZWlnaHQ9IjE0IiB2aWV3Qm94PSIwIDAgOCAxNCIgZmlsbD0ibm9uZSI+CjxnIGlkPSJHbG9iYWwgw6LCgMKTIEljb25zIj4KPHBhdGggaWQ9IlZlY3RvciA4IiBkPSJNMSAxLjVMNyA3TDEgMTIuNSIgc3Ryb2tlPSIjMDA2M0MzIiBzdHJva2Utd2lkdGg9IjEuNSIgc3Ryb2tlLWxpbmVjYXA9InJvdW5kIiBzdHJva2UtbGluZWpvaW49InJvdW5kIi8+CjwvZz4KPC9zdmc+);background-repeat:no-repeat;background-position:center;width:100%;height:100%}
.aemform form .back-button button{float:left !important}
.aemform form .back-button button::before{content:"";display:block;background-image:url(data:image/svg+xml;base64,PHN2ZyB4bWxucz0iaHR0cDovL3d3dy53My5vcmcvMjAwMC9zdmciIHdpZHRoPSI4IiBoZWlnaHQ9IjE0IiB2aWV3Qm94PSIwIDAgOCAxNCIgZmlsbD0ibm9uZSI+CjxnIGlkPSJHbG9iYWwgw6LCgMKTIEljb25zIj4KPHBhdGggaWQ9IlZlY3RvciA5IiBkPSJNNyAxLjVMMSA3TDcgMTIuNSIgc3Ryb2tlPSIjMDA2M0MzIiBzdHJva2Utd2lkdGg9IjEuNSIgc3Ryb2tlLWxpbmVjYXA9InJvdW5kIiBzdHJva2UtbGluZWpvaW49InJvdW5kIi8+CjwvZz4KPC9zdmc+);background-repeat:no-repeat;background-position:center;width:100%;height:100%}
.aemform form .back-button button::after{display:none !important}
.aemform form .next-button button:disabled{opacity:.35;background-color:var(--form-btn-disabled-bg)}
.aemform form .next-button button:disabled:hover{background-color:var(--white);transform:scale(1)}
.aemform .dob-label.date-label-error{color:var(--form-error-color) !important;font-style:normal}
.aemform .dob-label.date-label-error span.tooltip-icon::after{background-image:url(data:image/svg+xml;base64,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)}
.aemform .cmp-adaptiveform-radiobutton__option-label{align-items:center}
.aemform .dropdown select:focus,.aemform .textinput input:focus{outline:0;color:var(--form-input-text-color);background-color:var(--white);border-color:var(--form-input-color-focus);outline:0;box-shadow:0 0 0 .2rem rgba(0,123,255,.2509803922)}
.aemform .cmp-adaptiveform-radiobutton__option__widget{cursor:pointer;appearance:none;position:static;margin-right:.3125rem !important}
.aemform .cmp-adaptiveform-radiobutton__option__widget::after{content:"";width:.938rem;height:.938rem;display:block;background-color:var(--white);border-width:.063rem;border-style:solid;border-color:var(--form-primary-color);border-radius:50%}
.aemform .cmp-adaptiveform-radiobutton__option__widget:checked::after{background-color:var(--form-primary-color)}
.aemform .cmp-adaptiveform-checkbox__widget,.aemform .cmp-adaptiveform-checkboxgroup__option__widget{appearance:none;position:relative;margin-right:.3125rem !important;margin-top:0rem !important;padding-left:0rem !important;border:0;cursor:pointer}
.aemform .cmp-adaptiveform-checkbox__widget::after,.aemform .cmp-adaptiveform-checkboxgroup__option__widget::after{content:"";border:1.5px solid var(--form-primary-color);display:block;background-color:var(--white);width:.813rem;height:.813rem;opacity:1}
.aemform .cmp-adaptiveform-checkbox__widget:checked::before,.aemform .cmp-adaptiveform-checkboxgroup__option__widget:checked::before{border:solid;border-width:0 0 1.5px 1.5px;border-color:var(--form-primary-color);height:.306rem;width:.5rem;transform:rotate(-50deg);top:.25rem;bottom:auto;content:"";display:block;position:absolute;left:.188rem;opacity:1}
.aemform .dropdown:has(select.date-dropdown){max-width:8.188rem;width:auto !important;margin-right:.5rem !important}
@media(max-width:567px){.aemform .dropdown:has(select.date-dropdown){width:calc(31.33% - 8px) !important;max-width:unset;min-width:5.25rem}
}
.aemform .dropdown:has(select.date-dropdown) select.date-dropdown{border-radius:0;width:8.188rem;height:2.5rem;padding:.5rem !important;color:var(--form-border-color) !important;border:.063rem solid var(--form-border-color)}
.aemform .dropdown:has(select.date-dropdown) select.date-dropdown:valid{color:var(--form-text-color) !important}
.aemform .dropdown:has(select.date-dropdown) select.date-dropdown+.cmp-adaptiveform-dropdown__errormessage{display:none !important}
@media(max-width:567px){.aemform .dropdown:has(select.date-dropdown) select.date-dropdown{width:auto !important;font-size:.75rem}
}
.aemform .dropdown:has(select.date-dropdown)~.text:not(:has([class*=error])) p{font-size:.875rem;margin-bottom:1.25rem !important}
.aemform .dob-label{position:relative}
.aemform .dob-label span.tooltip-icon::after{content:"";background-image:url(data:image/svg+xml;base64,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);width:13px;height:13px;display:inline-block;margin-left:.3125rem !important}
.aemform .dob-label span.tooltip-icon .tooltip-box{display:none;color:var(--form-base-color)}
.aemform .dob-label span.tooltip-icon:hover .tooltip-box{display:block;position:absolute;top:-65px;margin-left:-15px;margin-bottom:5px;background-color:var(--white);border:2px solid var(--white);border-radius:4px;padding:4px 8px;width:243px;height:56px;z-index:1;font-size:14px;box-shadow:0 2px 6px rgba(0,0,0,.15);text-align:center}
.aemform .aem-Grid:has(>.checkbox+.image+.text){padding:.75rem !important}
.aemform .aem-Grid:has(>.checkbox+.image+.text)>.checkbox{width:auto !important;margin-right:1rem}
.aemform .aem-Grid:has(>.checkbox+.image+.text)>.image{width:auto !important;margin-right:1.5rem}
.aemform .aem-Grid:has(>.checkbox+.image+.text)>.image img{width:10.063rem;height:5.625rem;border:unset;background-color:unset}
.aemform .aem-Grid:has(>.checkbox+.image+.text)>.text{width:calc(100% - 13.875rem) !important}
@media(max-width:600px){.aemform .aem-Grid:has(>.checkbox+.image+.text)>.text{width:auto !important}
}
.aemform .aem-Grid:has(>.checkbox+.image+.text)>.text p:first-child{color:var(--form-primary-color);font-weight:700;font-size:1.125rem}
.aemform .aem-Grid:has(>.checkbox+.image+.text)>.text+.radiobutton{width:auto !important;margin-left:13.875rem}
@media(max-width:600px){.aemform .aem-Grid:has(>.checkbox+.image+.text)>.text+.radiobutton{width:auto !important;margin-left:0 !important}
}
.aemform .wizard .cmp-adaptiveform-wizard{position:relative;padding:0rem !important;margin:0rem;border:0;background:rgba(0,0,0,0)}
.aemform .wizard .cmp-adaptiveform-wizard__widget{position:relative}
.aemform .wizard .cmp-adaptiveform-wizard__tabList{position:relative;padding-bottom:1.75rem !important;margin-top:.9375rem !important;margin-bottom:.3125rem !important}
.aemform .wizard .cmp-adaptiveform-wizard__tabList::before,.aemform .wizard .cmp-adaptiveform-wizard__tabList::after{content:"";display:block;height:1.188rem;width:100%;border-radius:.938rem;position:absolute;bottom:0}
.aemform .wizard .cmp-adaptiveform-wizard__tabList::before{border:solid .063rem var(--form-base-color)}
.aemform .wizard .cmp-adaptiveform-wizard__tabList::after{bottom:.063rem;height:1.063rem;background:var(--form-primary-color);width:var(--wizard-progress,20%);transition:width .5s ease}
.aemform .wizard .cmp-adaptiveform-wizard__tab{display:none !important;color:var(--form-primary-color);border-bottom:0;padding:0rem !important}
.aemform .wizard .cmp-adaptiveform-wizard__tab--active{display:block !important}
.aemform .wizard .cmp-adaptiveform-wizard__tab::before{display:none}
.aemform .wizard .cmp-adaptiveform-wizard__wizardpanel:first-child .cmp-adaptiveform-radiobutton__option-label{flex-direction:row-reverse}
.aemform .wizard .cmp-adaptiveform-wizard__wizardpanel .cmp-container{color:var(--form-primary-color)}
.aemform .wizard .cmp-adaptiveform-wizard__wizardpanel .cmp-container__shortdescription{font-style:italic}
.aemform .wizard .cmp-adaptiveform-wizard__wizardpanel .cmp-container__shortdescription *{color:var(--form-primary-color)}
.aemform .wizard .cmp-adaptiveform-wizard__containerNav{display:none}
.aemform .accordion .cmp-accordion{display:flex;flex-direction:column;gap:.625rem}
.aemform .accordion .cmp-accordion__item{border:none !important;box-shadow:0 .375rem .75rem rgba(0,0,0,.15)}
.aemform .accordion .cmp-accordion__header{background:rgba(0,0,0,0)}
.aemform .accordion .cmp-accordion__header button{font-family:"Poppins-Regular","Helvetica, Arial, sans-serif";font-size:1rem;font-weight:600;line-height:1.2rem;color:var(--form-primary-color) !important;padding:.375rem .75rem;display:flex;justify-content:space-between;width:100%}
.aemform .accordion .cmp-accordion__header button .cmp-accordion__icon{transform:none;background-color:rgba(0,0,0,0);border:1px solid rgba(0,0,0,0);padding-top:.375rem;padding-bottom:.375rem;padding-left:.75rem;padding-right:.75rem;border-radius:.25rem;margin:0rem;background-image:url(data:image/svg+xml;base64,PHN2ZyB4bWxucz0iaHR0cDovL3d3dy53My5vcmcvMjAwMC9zdmciIGhlaWdodD0iMjRweCIgdmlld0JveD0iMCAtOTYwIDk2MCA5NjAiIHdpZHRoPSIyNHB4IiBmaWxsPSIjMDA2M2MzIj48cGF0aCBkPSJNNDgwLTM0NCAyNDAtNTg0bDU2LTU2IDE4NCAxODQgMTg0LTE4NCA1NiA1Ni0yNDAgMjQwWiIvPjwvc3ZnPg==);background-repeat:no-repeat;background-position:center;width:3.125rem;height:2.375rem}
.aemform .accordion .cmp-accordion__header .cmp-accordion__button--expanded .cmp-accordion__icon{background-image:url(data:image/svg+xml;base64,PHN2ZyB4bWxucz0iaHR0cDovL3d3dy53My5vcmcvMjAwMC9zdmciIGhlaWdodD0iMjRweCIgdmlld0JveD0iMCAtOTYwIDk2MCA5NjAiIHdpZHRoPSIyNHB4IiBmaWxsPSIjMDA2M2MzIj48cGF0aCBkPSJNNDgwLTUyOCAyOTYtMzQ0bC01Ni01NiAyNDAtMjQwIDI0MCAyNDAtNTYgNTYtMTg0LTE4NFoiLz48L3N2Zz4=)}
.aemform .accordion .cmp-accordion__panel{background:rgba(0,0,0,0);padding-top:1.25rem !important;padding-bottom:2.5rem !important;padding-left:1.75rem;padding-right:1.75rem}
@media(max-width:567px){.aemform .accordion .cmp-accordion__panel{padding-left:.9375rem;padding-right:.9375rem}
}
.aemform .accordion .cmp-accordion .cmp-adaptiveform-radiobutton:has([name*=insuranceType]) .cmp-adaptiveform-radiobutton__widget{gap:1.5rem;margin-top:2rem !important}
@media(max-width:567px){.aemform .accordion .cmp-accordion .cmp-adaptiveform-radiobutton:has([name*=insuranceType]) .cmp-adaptiveform-radiobutton__widget{display:unset}
}
.aemform .accordion .cmp-accordion .cmp-adaptiveform-radiobutton:has([name*=insuranceType]) .cmp-adaptiveform-radiobutton__option{padding:.375rem !important;margin-bottom:.5rem !important;border:.063rem solid var(--form-border-color);width:14rem;height:9.375rem;text-align:center;display:flex;flex-direction:column;gap:.313rem;border-radius:.25rem;flex:1 1 45%}
@media(max-width:567px){.aemform .accordion .cmp-accordion .cmp-adaptiveform-radiobutton:has([name*=insuranceType]) .cmp-adaptiveform-radiobutton__option{margin-top:1rem;height:9.438rem;width:100%}
}
@media(min-width:600px){.aemform .accordion .cmp-accordion .cmp-adaptiveform-radiobutton:has([name*=insuranceType]) .cmp-adaptiveform-radiobutton__option{flex:0 0 48%;min-width:21.563rem;max-width:50%}
}
@media(min-width:768px)and (max-width:992px){.aemform .accordion .cmp-accordion .cmp-adaptiveform-radiobutton:has([name*=insuranceType]) .cmp-adaptiveform-radiobutton__option{flex:0 0 48%;min-width:21.563rem;max-width:50%}
}
.aemform .accordion .cmp-accordion .cmp-adaptiveform-radiobutton:has([name*=eligibleForMedicare]){border:unset;padding:unset}
.aemform .insurance_info_panel .aem-Grid>.text+.radiobutton .cmp-adaptiveform-radiobutton[data-cmp-valid=false] .cmp-adaptiveform-radiobutton__label-container label{color:var(--form-text-color) !important}
.aemform .patient_authorization_consent_panel .co-pay{background-color:var(--form-scroller-bg-color);padding-left:1.5rem;padding-right:1.5rem;padding-top:1.5rem !important;overflow:hidden}
.aemform .patient_authorization_consent_panel .accordion{position:relative}
.aemform .patient_authorization_consent_panel .cmp-adaptiveform-radiobutton__errormessage{position:absolute;top:-27px;display:block;right:4px}
@media(max-width:575.98px){.aemform .patient_authorization_consent_panel .cmp-adaptiveform-radiobutton__errormessage{right:0}
}
.aemform .patient_authorization_consent_panel .cmp-accordion__header button .cmp-accordion__icon{background-image:url(data:image/svg+xml;base64,PHN2ZyB4bWxucz0iaHR0cDovL3d3dy53My5vcmcvMjAwMC9zdmciIGhlaWdodD0iMjRweCIgdmlld0JveD0iMCAtOTYwIDk2MCA5NjAiIHdpZHRoPSIyNHB4IiBmaWxsPSIjMDA2M2MzIj48cGF0aCBkPSJNNDQwLTQ0MEgyMDB2LTgwaDI0MHYtMjQwaDgwdjI0MGgyNDB2ODBINTIwdjI0MGgtODB2LTI0MFoiLz48L3N2Zz4=)}
.aemform .patient_authorization_consent_panel .cmp-accordion__header .cmp-accordion__button--expanded .cmp-accordion__icon{background-image:url(data:image/svg+xml;base64,PHN2ZyB4bWxucz0iaHR0cDovL3d3dy53My5vcmcvMjAwMC9zdmciIGhlaWdodD0iMjRweCIgdmlld0JveD0iMCAtOTYwIDk2MCA5NjAiIHdpZHRoPSIyNHB4IiBmaWxsPSIjMDA2M2MzIj48cGF0aCBkPSJNMjAwLTQ0MHYtODBoNTYwdjgwSDIwMFoiLz48L3N2Zz4=)}
.aemform .patient_authorization_consent_panel .cmp-adaptiveform-radiobutton__errormessage{margin:0 !important}
.aemform .patient_authorization_consent_panel .fragment+.text.base .cmp-adaptiveform-text__label,.aemform .patient_authorization_consent_panel>.aem-Grid>.text.base .cmp-adaptiveform-text__label{display:flex;justify-content:space-between}
.aemform .patient_authorization_consent_panel .fragment+.text.base .cmp-adaptiveform-text__label>div>p::after,.aemform .patient_authorization_consent_panel>.aem-Grid>.text.base .cmp-adaptiveform-text__label>div>p::after{content:"";width:.438rem;height:.438rem;border-radius:50%;background-color:var(--consent-bullet-bg);margin-left:.625rem !important;margin-bottom:.125rem !important;display:inline-block}
.aemform .patient_authorization_consent_panel .fragment+.text.base:has(+.fragment input[type=radio][value=accept]:checked) .cmp-adaptiveform-text__label p::after,.aemform .patient_authorization_consent_panel>.aem-Grid>.text.base:has(+.fragment input[type=radio][value=accept]:checked) .cmp-adaptiveform-text__label p::after{background-color:var(--consent-active-bg)}
.aemform .patient_authorization_consent_panel .cmp-adaptiveform-checkbox__widget-container:has(>input[name=terms-and-condition]) .cmp-adaptiveform-checkbox__label{color:var(--body-color)}
.aemform .patient_authorization_consent_panel input[name=terms-and-condition]{margin-top:.3125rem !important}
.aemform .patient_authorization_consent_panel input[name=terms-and-condition]::after{content:"";display:block;background-color:var(--white);width:.813rem;height:.813rem;opacity:1;border-width:.094rem;border-style:solid;border-color:var(--form-primary-color);border-image:initial}
.aemform .patient_authorization_consent_panel input[name=terms-and-condition]:checked::before{top:unset;left:unset;margin-top:.2rem;margin-left:.2rem;height:.306rem;width:.5rem;transform:rotate(-50deg);bottom:auto;content:"";display:block;position:absolute;opacity:1;border-style:solid;border-image:initial;border-width:0 0 1.5px 1.5px;border-color:var(--form-primary-color)}
.aemform .patient_authorization_consent_panel .cmp-accordion__button{padding:.625rem !important;position:relative}
.aemform .patient_authorization_consent_panel .cmp-accordion__button.has-collapsed-consent-error:not(.cmp-accordion__button--expanded)::after{content:attr(data-collapsed-consent-error);position:absolute;top:-39px;right:.313rem;font-weight:400;font-size:.875rem;display:block;font-style:italic;color:var(--form-error-color)}
@media(max-width:575.98px){.aemform .patient_authorization_consent_panel .cmp-accordion__button.has-collapsed-consent-error:not(.cmp-accordion__button--expanded)::after{right:0}
}
.aemform .patient_authorization_consent_panel .cmp-accordion__header{position:relative}
.aemform .patient_authorization_consent_panel .cmp-accordion__header .cmp-accordion__title,.aemform .patient_authorization_consent_panel .cmp-accordion__header .cmp-accordion__title p{font-weight:700;line-height:1.5rem;color:var(--form-primary-color) !important}
@media(max-width:575.98px){.aemform .patient_authorization_consent_panel .cmp-accordion__header .cmp-accordion__title,.aemform .patient_authorization_consent_panel .cmp-accordion__header .cmp-accordion__title p{font-size:.75rem;line-height:.938rem}
}
.aemform .patient_authorization_consent_panel .cmp-accordion__panel .scroller{background-color:var(--form-scroller-bg-color);line-height:1.5rem;height:20.75rem;padding:1rem;overflow:auto}
.aemform .patient_authorization_consent_panel .cmp-accordion__panel a{color:var(--form-primary-color)}
.aemform .patient_authorization_consent_panel .cmp-accordion__panel{padding:.625rem !important}
.aemform .patient_authorization_consent_panel .cmp-accordion__panel li,.aemform .patient_authorization_consent_panel .cmp-accordion__panel p{color:var(--body-color)}
.aemform .patient_authorization_consent_panel .cmp-accordion__panel p{display:block;margin-bottom:1rem !important}
@media(max-width:575.98px){.aemform .patient_authorization_consent_panel .cmp-accordion__panel p{font-size:.75rem;line-height:1.125rem}
}
.aemform .patient_authorization_consent_panel .cmp-accordion__panel ul{margin-bottom:.625rem !important;margin-left:1.5rem !important;list-style:disc}
.aemform .patient_authorization_consent_panel .cmp-accordion__panel .cmp-adaptiveform-radiobutton__option-label{gap:1.25rem;margin-bottom:1.0625rem !important;color:var(--form-radio-label-color)}
.aemform .patient_authorization_consent_panel .panel-card{border:none !important;box-shadow:0 .375rem .75rem rgba(0,0,0,.15)}
.aemform .patient_authorization_consent_panel .panel-card a{color:var(--form-primary-color)}
.aemform .patient_authorization_consent_panel .panel-card p{display:block;margin-bottom:1rem !important}
.aemform .patient_authorization_consent_panel .panel-card h6{font-size:1rem;font-weight:600;color:var(--form-primary-color);margin-bottom:.5rem !important}
.aemform .patient_authorization_consent_panel .panel-card .cmp-adaptiveform-text{padding:.625rem !important}
.aemform .cmp-adaptiveform-wizard__wizardpanel .patient_authorization_consent_panel li,.aemform .cmp-adaptiveform-wizard__wizardpanel .patient_authorization_consent_panel p{color:var(--form-text-color) !important}
@media(max-width:575.98px){.aemform .cmp-adaptiveform-wizard__wizardpanel .patient_authorization_consent_panel li,.aemform .cmp-adaptiveform-wizard__wizardpanel .patient_authorization_consent_panel p{font-size:.75rem;line-height:1.125rem}
}
.aemform .personal_info_panel>.fragment>.cmp-container>.aem-Grid{display:flex}
.aemform .personal_info_panel>.fragment>.cmp-container>.aem-Grid .cmp-adaptiveform-radiobutton[data-name=suggested_address]{padding-left:.5rem !important;padding-right:1rem !important;margin-top:.5rem !important;border:1px solid var(--form-error-color);font-size:.875rem}
.aemform .personal_info_panel>.fragment>.cmp-container>.aem-Grid .cmp-adaptiveform-radiobutton[data-name=suggested_address] .cmp-adaptiveform-radiobutton__label{color:var(--form-error-color);font-weight:700}
.aemform .personal_info_panel>.fragment>.cmp-container>.aem-Grid .cmp-adaptiveform-radiobutton[data-name=suggested_address] .cmp-adaptiveform-radiobutton__widget{justify-content:space-between;margin-top:.3125rem !important;flex-wrap:wrap}
.aemform .personal_info_panel>.fragment>.cmp-container>.aem-Grid .cmp-adaptiveform-radiobutton[data-name=suggested_address] .cmp-adaptiveform-radiobutton__option{display:flex;flex-direction:column}
.aemform .personal_info_panel>.fragment>.cmp-container>.aem-Grid .cmp-adaptiveform-radiobutton[data-name=suggested_address] .radio-title{color:var(--form-primary-color)}
.aemform .personal_info_panel>.fragment>.cmp-container>.aem-Grid .cmp-adaptiveform-radiobutton[data-name=suggested_address] .cmp-adaptiveform-radiobutton__option-label{margin-top:.3125rem !important;line-height:normal;border:1px solid var(--form-primary-color);border-image:initial;padding:.5rem !important}
.aemform .personal_info_panel>.fragment>.cmp-container>.aem-Grid .cmp-adaptiveform-radiobutton[data-name=suggested_address] .cmp-adaptiveform-radiobutton__option-label span{float:left;padding-left:.875rem !important}
.aemform .personal_info_panel>.fragment>.cmp-container>.aem-Grid .cmp-adaptiveform-radiobutton[data-name=suggested_address] .cmp-adaptiveform-radiobutton__option-label input{float:left;height:.938rem;width:.938rem;margin-top:.5rem !important;cursor:pointer;appearance:none}
.aemform .personal_info_panel>.fragment>.cmp-container>.aem-Grid .cmp-adaptiveform-radiobutton[data-name=suggested_address] .cmp-adaptiveform-radiobutton__option-label input::after{content:"";border:1px solid var(--form-primary-color);width:.938rem;height:.938rem;display:block;background-color:var(--white);border-radius:50%}
.aemform .personal_info_panel>.fragment>.cmp-container>.aem-Grid .cmp-adaptiveform-radiobutton[data-name=suggested_address] .cmp-adaptiveform-radiobutton__option-label input:checked::after{background-color:var(--form-primary-color)}
.aemform .personal_info_panel>.fragment>.cmp-container>.aem-Grid .cmp-adaptiveform-radiobutton[data-name=suggested_address] .radio-title,.aemform .personal_info_panel>.fragment>.cmp-container>.aem-Grid .cmp-adaptiveform-radiobutton[data-name=suggested_address] .cmp-adaptiveform-radiobutton__option-label{font-size:.875rem;line-height:normal}
.aemform .personal_info_panel>.fragment>.cmp-container>.aem-Grid .cmp-adaptiveform-textinput__errormessage{margin:0 !important}
.aemform .personal_info_panel>.fragment>.cmp-container>.aem-Grid .cmp-adaptiveform-dropdown,.aemform .personal_info_panel>.fragment>.cmp-container>.aem-Grid .cmp-adaptiveform-textinput,.aemform .personal_info_panel>.fragment>.cmp-container>.aem-Grid .cmp-adaptiveform-telephoneinput,.aemform .personal_info_panel>.fragment>.cmp-container>.aem-Grid .cmp-adaptiveform-emailinput{margin:0 !important}
@media(max-width:575.98px){.aemform .personal_info_panel>.fragment>.cmp-container>.aem-Grid{flex-direction:column}
}
.aemform .personal_info_panel>.fragment>.cmp-container>.aem-Grid .textinput input,.aemform .personal_info_panel>.fragment>.cmp-container>.aem-Grid .dropdown select{padding-top:.625rem;padding-bottom:.625rem;padding-left:.75rem;padding-right:.75rem;transition:all ease .2s;width:100%;display:block;color:var(--form-input-text-color);background-color:var(--white);background-clip:padding-box;border:1px solid var(--input-border);border-radius:unset}
.aemform .personal_info_panel>.fragment>.cmp-container>.aem-Grid .textinput input:-webkit-autofill{-webkit-box-shadow:0 0 0 10000px var(--white) inset}
.aemform .personal_info_panel>.fragment>.cmp-container>.aem-Grid .cmp-adaptiveform-dropdown__widget{padding:0 !important;padding-left:.5rem !important;margin-top:.5rem !important}
.aemform .personal_info_panel>.fragment>.cmp-container>.aem-Grid .cmp-adaptiveform-checkbox__widget-container{display:flex;align-items:center;gap:.75rem;margin-top:1.25rem !important}
.aemform .personal_info_panel>.fragment>.cmp-container>.aem-Grid .cmp-adaptiveform-checkbox__widget-container .cmp-adaptiveform-checkbox__label{margin:0;position:relative;padding-left:4.5rem !important;cursor:pointer;color:var(--form-primary-color)}
.aemform .personal_info_panel>.fragment>.cmp-container>.aem-Grid .cmp-adaptiveform-checkbox__widget-container .cmp-adaptiveform-checkbox__label::before{content:"";position:absolute;left:0;top:50%;transform:translateY(-50%);width:3.75rem;height:2rem;background-color:var(--white);border:5px solid var(--form-primary-color);border-radius:2.125rem;transition:.4s;box-sizing:border-box}
.aemform .personal_info_panel>.fragment>.cmp-container>.aem-Grid .cmp-adaptiveform-checkbox__widget-container .cmp-adaptiveform-checkbox__label::after{content:"";position:absolute;left:.563rem;top:50%;transform:translateY(-50%);width:1.125rem;height:1.125rem;background-color:var(--form-primary-color);border-radius:50%;transition:.4s}
.aemform .personal_info_panel>.fragment>.cmp-container>.aem-Grid .cmp-adaptiveform-checkbox__widget-container .cmp-adaptiveform-checkbox__widget{position:absolute;opacity:0;margin:0}
.aemform .personal_info_panel>.fragment>.cmp-container>.aem-Grid .cmp-adaptiveform-checkbox__widget-container .cmp-adaptiveform-checkbox__widget:checked+.cmp-adaptiveform-checkbox__label::after{transform:translateY(-50%) translateX(26px)}
.aemform .personal_info_panel>.fragment>.cmp-container>.aem-Grid .checkbox:has([name=healthcare_representative_assisting]){margin-bottom:1.5rem !important}
.aemform .personal_info_panel>.fragment>.cmp-container>.aem-Grid .textinput,.aemform .personal_info_panel>.fragment>.cmp-container>.aem-Grid .dropdown{margin-bottom:1.125rem !important}
@media(max-width:575.98px){.aemform .personal_info_panel>.fragment>.cmp-container>.aem-Grid .textinput,.aemform .personal_info_panel>.fragment>.cmp-container>.aem-Grid .dropdown{margin:0 !important;width:100% !important}
}
.aemform .personal_info_panel>.fragment>.cmp-container>.aem-Grid .textinput.aem-GridColumn--default--6,.aemform .personal_info_panel>.fragment>.cmp-container>.aem-Grid .textinput.aem-GridColumn--default--5,.aemform .personal_info_panel>.fragment>.cmp-container>.aem-Grid .dropdown.aem-GridColumn--default--6,.aemform .personal_info_panel>.fragment>.cmp-container>.aem-Grid .dropdown.aem-GridColumn--default--5{width:45.83%}
.aemform .personal_info_panel>.fragment>.cmp-container>.aem-Grid .textinput:has(>[data-cmp-visible=false]),.aemform .personal_info_panel>.fragment>.cmp-container>.aem-Grid .dropdown:has(>[data-cmp-visible=false]){display:none !important}
.aemform .personal_info_panel>.fragment>.cmp-container>.aem-Grid .textinput:has(>[data-cmp-visible=false])+.aem-GridColumn--offset--default--1,.aemform .personal_info_panel>.fragment>.cmp-container>.aem-Grid .dropdown:has(>[data-cmp-visible=false])+.aem-GridColumn--offset--default--1{margin-left:0 !important}
.aemform .program_question_panel .cmp-adaptiveform-radiobutton__option-label{align-items:center}
.aemform .program_question_panel .checkboxgroup:has([name=conditionChk]),.aemform .program_question_panel .checkbox:has([name=courtesyInjectionReminder]),.aemform .program_question_panel .checkbox:has([name=courtesyRefillReminder]){margin-left:1.5rem !important}
.aemform .program_question_panel .checkbox:has([name=courtesyInjectionReminder])+.text,.aemform .program_question_panel .checkbox:has([name=courtesyRefillReminder])+.text,.aemform .program_question_panel .panelcontainer:has([name=firstrefillreminder-month]),.aemform .program_question_panel .radiobutton:has([name*=injectiontake]),.aemform .program_question_panel .radiobutton:has([name*=refillreminder]),.aemform .program_question_panel .panelcontainer:has([name=firstdose-month]),.aemform .program_question_panel .checkboxgroup:has([name=communication]){margin-left:3rem !important}
.aemform .program_question_panel .textinput:has([name=surveymobile_phone]),.aemform .program_question_panel .dropdown:has([name=timezone]){width:55% !important;padding-left:3rem !important}
@media(max-width:575.98px){.aemform .program_question_panel .textinput:has([name=surveymobile_phone]),.aemform .program_question_panel .dropdown:has([name=timezone]){width:100% !important}
}
.aemform .program_question_panel .cmp-adaptiveform-checkbox__widget[name=courtesyInjectionReminder],.aemform .program_question_panel .cmp-adaptiveform-checkbox__widget[name=courtesyRefillReminder]{padding-left:0rem !important}
.aemform .program_question_panel .fragment:has([name=surveyaddress1]){padding-left:3rem !important}
.aemform .program_question_panel .fragment:has([name=surveyaddress1]) .cmp-adaptiveform-dropdown,.aemform .program_question_panel .fragment:has([name=surveyaddress1]) .cmp-adaptiveform-textinput{margin:0 !important}
@media(max-width:575.98px){.aemform .program_question_panel .fragment:has([name=surveyaddress1]) .textinput,.aemform .program_question_panel .fragment:has([name=surveyaddress1]) .dropdown{margin:0 !important;width:100% !important}
}
.aemform .program_question_panel .fragment>.cmp-container .aem-Grid:has(input[name=surveyaddress1]){display:flex}
@media(max-width:575.98px){.aemform .program_question_panel .fragment>.cmp-container .aem-Grid:has(input[name=surveyaddress1]){flex-direction:column}
}
.aemform .program_question_panel .cmp-adaptiveform-textinput__widget,.aemform .program_question_panel .cmp-adaptiveform-dropdown__widget{border:1px solid var(--input-border);border-radius:unset}
.aemform .program_question_panel .cmp-adaptiveform-textinput__widget{padding-top:.625rem;padding-bottom:.625rem;padding-left:.75rem;padding-right:.75rem;transition:all ease .2s}
.aemform .program_question_panel .cmp-adaptiveform-textinput__widget:disabled{background-color:var(--input-disabled-bg);opacity:1}
.aemform .program_question_panel .cmp-adaptiveform-dropdown__widget{padding:0 !important;padding-left:.5rem !important;margin-top:.625rem !important;color:var(--input-border)}
.aemform .program_question_panel .cmp-adaptiveform-dropdown__widget:disabled{background-color:var(--input-disabled-bg);opacity:1}
.aemform .program_question_panel .text:has(>.cmp-adaptiveform-text>div .skip-this-section){margin-bottom:1.125rem !important;position:relative}
.aemform .program_question_panel .text:has(>.cmp-adaptiveform-text>div .skip-this-section) .cmp-adaptiveform-text__label{margin:0 !important}
.aemform .program_question_panel .text:has(>.cmp-adaptiveform-text>div .skip-this-section) .cmp-adaptiveform-text>div{border-top:2px dotted #89a;text-align:center;font-size:.875rem}
.aemform .program_question_panel .text:has(>.cmp-adaptiveform-text>div .skip-this-section) .skip-this-section{cursor:pointer;color:var(--form-primary-color);font-weight:700}
.aemform .program_question_panel .cmp-adaptiveform-checkboxgroup__widget:has(.optional3){flex-direction:column;gap:.5rem}
.aemform .program_question_panel .cmp-adaptiveform-dropdown__widget[name=optional2]{padding-left:.5rem !important;width:50%}
.aemform .program_question_panel .cmp-adaptiveform-radiobutton__widget:has([name*=optional1]){display:flex;gap:1rem}
.aemform .program_question_panel:has(.cmp-adaptiveform-checkbox[data-cmp-valid=false] input[name=courtesyInjectionReminder]):has(.cmp-adaptiveform-checkbox[data-cmp-valid=false] input[name=courtesyRefillReminder]) .checkbox:has(input[name=courtesyInjectionReminder]) .cmp-adaptiveform-checkbox__errormessage{display:none}
.aemform .submit-button>.cmp-adaptiveform-button .cmp-adaptiveform-button__widget{background-color:var(--form-primary-color);border:0;position:relative;display:block;width:11.25rem;height:3.125rem;cursor:pointer;font-weight:600;margin-left:auto;text-align:left;padding:.75rem !important;line-height:1.5rem;border-radius:.25rem}
.aemform .submit-button>.cmp-adaptiveform-button .cmp-adaptiveform-button__widget .cmp-adaptiveform-button__text{color:var(--white);padding-left:.625rem !important}
.aemform .submit-button>.cmp-adaptiveform-button .cmp-adaptiveform-button__widget .cmp-adaptiveform-button__text::after{content:"";display:block;position:absolute;background-image:url(data:image/svg+xml;base64,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);background-repeat:no-repeat;background-position:center;width:1.563rem;height:1.563rem;right:18%;bottom:24%}
.aemform .submit-button>.cmp-adaptiveform-button .cmp-adaptiveform-button__widget:disabled{opacity:.65}
.aemform .thankyou-panel,.aemform .service-panel,.aemform .copay-card-panel{padding-top:2.625rem;padding-bottom:2.625rem;padding-left:3.25rem;padding-right:3.25rem;display:none}
.aemform .thankyou-panel .cmp-container{display:flex;flex-direction:column;justify-content:center;margin-top:2rem !important}
.aemform .thankyou-panel .cmp-adaptiveform-text__label p{margin-bottom:1rem !important}
.aemform .thankyou-panel .cmp-adaptiveform-text>div>p:first-child{font-weight:700;font-size:1.75rem;color:var(--form-primary-color)}
.aemform .thankyou-panel .cmp-adaptiveform-button__widget{background-image:url(data:image/svg+xml;base64,PHN2ZyB3aWR0aD0iOCIgaGVpZ2h0PSIxNCIgdmlld0JveD0iMCAwIDggMTQiIGZpbGw9Im5vbmUiIHhtbG5zPSJodHRwOi8vd3d3LnczLm9yZy8yMDAwL3N2ZyI+CjxnIGlkPSJHbG9iYWwgJiMyMjY7JiMxMjg7JiMxNDc7IEljb25zIj4KPHBhdGggaWQ9IlZlY3RvciA5IiBkPSJNNyAxLjVMMSA3TDcgMTIuNSIgc3Ryb2tlPSIjMDA2M0MzIiBzdHJva2Utd2lkdGg9IjEuNSIgc3Ryb2tlLWxpbmVjYXA9InJvdW5kIiBzdHJva2UtbGluZWpvaW49InJvdW5kIi8+CjwvZz4KPC9zdmc+);background-repeat:no-repeat;background-position:.938rem center;background-size:.938rem .938rem;width:auto;line-height:.938rem;border:1px solid var(--form-primary-color);color:var(--form-primary-color);text-align:center;vertical-align:middle;display:inline-block;font-weight:400;padding-right:.75rem !important;padding-top:.375rem;padding-bottom:.375rem;height:3.125rem;margin-top:.5rem !important;border-radius:.25rem;padding-left:2.5rem !important;padding-left:2.5rem;display:inline-flex;text-decoration:none}
.aemform .thankyou-panel .cmp-adaptiveform-button__widget:hover{background-color:var(--white)}
.aemform .error-panel{display:none}
.aemform .error-panel .cmp-container{color:var(--form-radio-label-color);font-style:normal;padding:1.5rem !important}
.aemform .error-panel .cmp-container .cmp-adaptiveform-text__label p{font-weight:inherit;font-size:inherit;margin-bottom:1rem !important;color:var(--form-radio-label-color)}
.aemform .error-panel .cmp-container .cmp-adaptiveform-text__label p:first-child{font-size:1.5rem;font-weight:700;color:var(--form-primary-color)}
.aemform .error-panel .cmp-container button:has(a){width:auto;height:auto;border:0;padding:0;margin:0}
.aemform .error-panel .cmp-container a{margin-top:.53125rem !important;margin-bottom:1.25rem !important;width:10.313rem;height:3.125rem;padding-top:.9375rem;padding-bottom:.9375rem;padding-left:1.5625rem;padding-right:1.5625rem;border-radius:.313rem;border:.063rem solid var(--form-primary-color);color:var(--form-primary-color) !important;text-decoration:none !important;background:0;font-weight:400;padding-left:2.5rem !important}
.aemform .error-panel .cmp-container a:hover{background-color:var(--white)}
.aemform .error-panel .service-panel .cmp-container{background-color:var(--service-panel-bg)}
.aemform .error-panel .service-panel .cmp-container>.text>.cmp-adaptiveform-text>div{text-align:center}
.aemform .error-panel .service-panel .cmp-container>.text>.cmp-adaptiveform-text>div h2,.aemform .error-panel .service-panel .cmp-container>.text>.cmp-adaptiveform-text>div p{padding-top:.9375rem;padding-bottom:.9375rem;padding-left:.3125rem;padding-right:.3125rem;font-family:"Poppins-Regular","Helvetica, Arial, sans-serif";font-size:1.75rem;font-weight:700;line-height:2.125rem}
.aemform .error-panel .service-panel .cmp-container>.text>.cmp-adaptiveform-text>div h2{color:var(--form-primary-color)}
.aemform .error-panel .service-panel .cmp-container>.text>.cmp-adaptiveform-text>div p{font-size:1.5rem;line-height:2.25rem}
.aemform .error-panel .service-panel .cmp-container .panelcontainer{padding-top:2rem !important}
.aemform .error-panel .service-panel .cmp-container .panelcontainer .text{margin-left:1.5rem !important}
@media(max-width:575.98px){.aemform .error-panel .service-panel .cmp-container .panelcontainer .text{margin-left:0rem !important;padding-top:1rem !important}
}
.aemform .error-panel .service-panel .cmp-container .panelcontainer>.cmp-container>.aem-grid{display:flex}
@media(max-width:575.98px){.aemform .error-panel .service-panel .cmp-container .panelcontainer>.cmp-container>.aem-grid{flex-direction:column}
}
.aemform .error-panel .service-panel .cmp-container .panelcontainer .cmp-image,.aemform .error-panel .service-panel .cmp-container .panelcontainer .cmp-image img{width:10.063rem;height:5.625rem;border:unset}
.aemform .error-panel .service-panel .cmp-container .panelcontainer p{margin-bottom:1rem !important;line-height:1.5rem;font-size:1rem}
.aemform .error-panel .service-panel .cmp-container .panelcontainer .cmp-adaptiveform-text p:first-child{margin-bottom:.5rem !important;font-size:1.125rem;font-weight:500;line-height:1.375rem;color:var(--form-primary-color)}
.aemform .error-panel .gatekepper-content,.aemform .error-panel .need-more-info-modal,.aemform .error-panel .trying-soon-modal,.aemform .error-panel .error-panel{display:none}
.aemform .copay-card-panel .cmp-container>.aem-Grid{display:flex;flex-wrap:wrap;align-items:flex-start;gap:1.5rem;row-gap:1rem}
.aemform .copay-card-panel .cmp-container .text.base{flex:0 0 100%;max-width:100%}
.aemform .copay-card-panel .cmp-container .text.base .cmp-adaptiveform-text__label h2{margin-bottom:2rem !important;font-family:"Poppins-Regular","Helvetica, Arial, sans-serif";font-size:1.75rem;font-weight:700;line-height:2.125rem;font-style:italic;color:var(--form-primary-color)}
.aemform .copay-card-panel .cmp-container .text.base .cmp-adaptiveform-text__label p{margin-bottom:1rem !important}
.aemform .copay-card-panel .cmp-container .image.base{flex:0 0 14.063rem;max-width:14.063rem;background-color:var(--copay-card-bg);border-radius:.375rem;display:flex;align-items:center;justify-content:center;height:9.375rem}
.aemform .copay-card-panel .cmp-container .image.base .cmp-image,.aemform .copay-card-panel .cmp-container .image.base .cmp-image img{width:100%;height:auto;display:block;object-fit:contain}
.aemform .copay-card-panel .cmp-container .panelcontainer{flex:1 1 26.25rem;min-width:20rem}
.aemform .copay-card-panel .cmp-container .panelcontainer .text.base:nth-of-type(2) .cmp-adaptiveform-text__label>div{display:grid;grid-template-columns:1fr 1fr}
@media(max-width:575.98px){.aemform .copay-card-panel .cmp-container .panelcontainer{flex:0 0 100%;max-width:100%}
}
.aemform .copay-card-panel .cmp-container .button.base{flex:0 0 14.375rem;max-width:14.375rem;align-self:center;margin-top:-30px}
@media(max-width:575.98px){.aemform .copay-card-panel .cmp-container .button.base{flex:0 0 100%;max-width:100%}
}
.aemform .copay-card-panel .cmp-container .cmp-adaptiveform-button__widget{width:100%;height:3.125rem;border:1px solid var(--form-primary-color);background-color:var(--white);border-radius:.25rem;display:inline-flex;align-items:center;justify-content:center;padding:.625rem !important;position:relative;cursor:pointer}
.aemform .copay-card-panel .cmp-container .cmp-adaptiveform-button__widget .cmp-adaptiveform-button__text{color:var(--form-primary-color);line-height:1.5}
.aemform .copay-card-panel .cmp-container .cmp-adaptiveform-button__widget::after{content:"";position:absolute;width:.688rem;height:.75rem;right:20%;top:50%;transform:translateY(-50%);background-image:url(data:image/svg+xml;base64,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);background-size:contain;background-repeat:no-repeat}
.aemform .copay-card-panel .image+.panelcontainer .cmp-container>.text.base:nth-child(2) .cmp-adaptiveform-text>div{display:flex;flex-wrap:wrap}
.aemform .copay-card-panel .image+.panelcontainer .cmp-container>.text.base:nth-child(2) .cmp-adaptiveform-text>div p{width:50%;margin:0}
.aemform .modal-dialog{margin-left:auto;margin-right:auto;width:auto;background:#fff}
.aemform .modal-dialog .aem-Grid.modal-content>.text{overflow-y:auto;padding-left:.9375rem !important;padding-right:.9375rem !important;margin-right:.625rem !important;margin-top:2rem !important;height:19.063rem}
.aemform .modal.show .modal-dialog{min-width:50.313rem;height:27.813rem;color:#0063c3;transform:translate(0,25%)}
.aemform .modal.show .modal-dialog .modal-content.cmp-container__label-container .cmp-container__label{text-align:center;border-bottom:.063rem solid #0063c3 !important;background-color:#fff !important;display:flex;justify-content:center;align-items:center;padding:.625rem;font-size:1rem;border-radius:0;color:#0063c3}
.aemform .modal.show .modal-dialog .modal-content.aem-Grid{border:0;background:rgba(0,0,0,0)}
.aemform .modal.show .modal-dialog .modal-content.aem-Grid p{color:#0063c3;text-align:justify}
.aemform .modal.show .modal-dialog .modal-content.aem-Grid .button.base{justify-content:center;display:flex}
.aemform .modal.show .modal-dialog .modal-content.aem-Grid .button.base button{display:block;width:11.25rem;height:3.125rem;padding-left:1.563rem;padding-right:1.563rem;background-color:#0063c3;color:#fff;border:0;cursor:pointer;text-align:center;font-size:1rem;font-weight:700;border-radius:.313rem;color:#fff}
.aemform .modal.show .modal-dialog .modal-content.aem-Grid .button.base button:hover{transform:scale(1.05)}
.aemform .modal.show .modal-dialog .modal-content.aem-Grid .button.base button:disabled{opacity:.5;background-color:#0063c3}
@media print{.aemform body *{visibility:hidden}
.aemform .copay-card-panel,.aemform .copay-card-panel *{visibility:visible}
.aemform .copay-card-panel{position:absolute;left:0;top:40%;width:100%}
.aemform .copay-card-panel .button.base,.aemform .copay-card-panel .cmp-adaptiveform-button{display:none !important}
.aemform .copay-card-panel h2{display:none !important}
.aemform .copay-card-panel>.cmp-container>.aem-Grid>.text.base:first-child{display:none !important}
.aemform .copay-card-panel .cmp-container>.aem-Grid{display:flex !important;flex-wrap:nowrap !important}
.aemform .copay-card-panel .cmp-container>.aem-Grid>.image.base{flex:0 0 28%;max-width:28%}
.aemform .copay-card-panel .cmp-container>.aem-Grid>.image.base .cmp-image,.aemform .copay-card-panel .cmp-container>.aem-Grid>.image.base .cmp-image img{width:100%;height:auto}
.aemform .copay-card-panel .cmp-container>.aem-Grid>.panelcontainer{flex:1 1 auto;max-width:72%;padding-top:1.5625rem !important;min-width:0}
.aemform .copay-card-panel .cmp-adaptiveform-text p{font-size:.625rem;line-height:1}
}
.copay-progressive-form .aemform .patient_authorization_consent_panel .fragment+.text.base:has(+.fragment input[type=radio][name$=_marketing_processing_consent]:checked) .cmp-adaptiveform-text__label p::after,.copay-progressive-form .aemform .patient_authorization_consent_panel .fragment+.text.base:has(+.fragment input[type=radio][name$=_marketing_disclosure_consent]:checked) .cmp-adaptiveform-text__label p::after,.copay-accordion-form .aemform .patient_authorization_consent_panel .fragment+.text.base:has(+.fragment input[type=radio][name$=_marketing_processing_consent]:checked) .cmp-adaptiveform-text__label p::after,.copay-accordion-form .aemform .patient_authorization_consent_panel .fragment+.text.base:has(+.fragment input[type=radio][name$=_marketing_disclosure_consent]:checked) .cmp-adaptiveform-text__label p::after{background-color:var(--consent-active-bg)}