.PatientRefillForm_patientRefillForm__CN_xX{display:flex;flex-direction:column;gap:1.5rem;width:100%}.PatientRefillForm_formGrid__dkIj1{display:grid;grid-gap:1.5rem;gap:1.5rem;grid-template-columns:1fr}@media (min-width:640px){.PatientRefillForm_formGrid__dkIj1{grid-template-columns:1fr 1fr}}.PatientRefillForm_label__Q0lMP{display:block;font-size:1rem;font-weight:500;color:var(--primary-dark-teal);margin-bottom:.5rem}.PatientRefillForm_input__o9PMh{margin-top:.5rem;width:100%;min-width:0;box-sizing:border-box;padding:.75rem 1rem;border:1px solid var(--neutral-light-gray);border-radius:.75rem;font-size:1rem;color:var(--neutral-off-black);background:var(--neutral-off-white);box-shadow:0 1px 2px 0 rgb(0 0 0/.05);transition:border-color .2s,box-shadow .2s;resize:none}.PatientRefillForm_input__o9PMh:focus{outline:2px solid transparent;outline-offset:2px;border-color:var(--primary-light-teal);box-shadow:0 0 0 2px var(--primary-light-teal)}.PatientRefillForm_input__o9PMh::placeholder{color:var(--neutral-medium-gray)}.PatientRefillForm_submitButton__CoQv6{width:100%;display:flex;justify-content:center;padding:.75rem 1.5rem;border:none;border-radius:.75rem;font-size:1rem;font-weight:700;color:var(--white);background:var(--primary-dark-teal);box-shadow:var(--shadow-md);cursor:pointer;transition:background .2s}.PatientRefillForm_submitButton__CoQv6:focus:not(:disabled),.PatientRefillForm_submitButton__CoQv6:hover:not(:disabled){background:var(--primary-light-teal)}.PatientRefillForm_submitButton__CoQv6:disabled{background:var(--neutral-medium-gray);cursor:not-allowed}.PatientRefillForm_errorMessage__vXuE6{color:#dc3545;font-size:.875rem;margin-top:.25rem;display:block}.PatientRefillForm_successMessage__DeClm{text-align:center;padding:2rem;background:#d4edda;border:1px solid #c3e6cb;border-radius:.75rem;color:#155724;box-shadow:var(--shadow-md)}.PatientRefillForm_successMessage__DeClm h3{margin-bottom:1rem;color:#155724;font-size:1.5rem;font-weight:700}.PatientRefillForm_successMessage__DeClm p{margin-bottom:.5rem;font-size:1rem;line-height:1.6}.PatientRefill_section__eb48C{padding-top:4rem;padding-bottom:4rem;background:var(--neutral-off-white)}.PatientRefill_container__gs0ya{max-width:1280px;margin-left:auto;margin-right:auto;padding-left:1rem;padding-right:1rem}.PatientRefill_grid__z_2pO{display:grid;grid-gap:4rem;gap:4rem;grid-template-columns:1fr}@media (min-width:1024px){.PatientRefill_grid__z_2pO{grid-template-columns:1fr 1fr;align-items:stretch}}.PatientRefill_formCard__pnF46{background:var(--white);padding:2rem;border-radius:1.5rem;box-shadow:var(--shadow-md);box-sizing:border-box}@media (min-width:640px){.PatientRefill_formCard__pnF46{padding:3rem}}.PatientRefill_title__j6MW1{font-size:2.25rem;font-weight:800;color:var(--neutral-off-black);line-height:1.2;margin:0 0 1rem}@media (min-width:768px){.PatientRefill_title__j6MW1{font-size:2.5rem}}.PatientRefill_subtitle__T3QJG{margin-bottom:2rem;font-size:1.125rem;color:var(--neutral-off-black)}.PatientRefill_form__V35RD{display:flex;flex-direction:column;gap:1.5rem}.PatientRefill_formGrid__VnQzy{display:grid;grid-gap:1.5rem;gap:1.5rem;grid-template-columns:1fr}@media (min-width:640px){.PatientRefill_formGrid__VnQzy{grid-template-columns:1fr 1fr;gap:1.5rem}}.PatientRefill_label__mm_h8{display:block;font-size:1rem;font-weight:500;color:var(--primary-dark-teal);margin-bottom:.25rem}.PatientRefill_input__r2q2l{width:100%;min-width:0;box-sizing:border-box;padding:.75rem 1rem;border:1px solid var(--neutral-light-gray);border-radius:.75rem;font-size:1rem;color:var(--neutral-off-black);background:var(--neutral-off-white);box-shadow:0 1px 2px 0 rgb(0 0 0/.05);transition:border-color .2s,box-shadow .2s;resize:none}.PatientRefill_input__r2q2l:focus{outline:2px solid transparent;outline-offset:2px;border-color:var(--primary-light-teal);box-shadow:0 0 0 2px var(--primary-light-teal)}.PatientRefill_submitButton__W8yL5{border-radius:.5rem;font-size:1.25rem;background:var(--primary-light-teal);margin-top:1.5rem;width:100%;display:flex;justify-content:center;padding:.75rem 1.5rem;border:none;border-radius:.75rem;font-size:1rem;font-weight:700;color:var(--white);background:var(--primary-dark-teal);box-shadow:var(--shadow-md);cursor:pointer;transition:background .2s}.PatientRefill_submitButton__W8yL5:focus,.PatientRefill_submitButton__W8yL5:hover{background:var(--primary-light-teal)}.PatientRefill_imageWrapper__qzlWY{position:relative;width:100%;min-height:400px;height:100%;border-radius:0 1.5rem 1.5rem 0;overflow:hidden;display:none}@media (min-width:1024px){.PatientRefill_imageWrapper__qzlWY{display:block}}.PatientRefill_image__r_Vv5{object-fit:cover;object-position:center}