#request-a-repPg-ID #mainBanr-wrapper .rowBanr-wrpr {
  padding: 74px 0 60px;
}
#request-a-repPg-ID #mainBanr-wrapper {
  min-height: 250px;
}
#request-a-repPg-ID button.cmp-dynamicform__clear-btn {
  display: none;
}

#request-a-repPg-ID #reqArep-bgContMain {
  background-color: #00927C0D;
  padding: 100px 0 50px;
}

#request-a-repPg-ID .rer-form-intro-text h3,
#request-a-repPg-ID .rer-form-intro-text p {
  text-align: left;
}

#request-a-repPg-ID .rer-form-intro-text p .mnl-txDngr {
  color: red;
}

#request-a-repPg-ID .rer-form-intro-text p.p-large-regular {
  margin: 18px 0 10px;
}

#request-a-repPg-ID .rer-form-intro-text a.lokLiv-anchlk {
  color: #00927C;
  text-decoration: underline;
}

#request-a-repPg-ID .rer-form-intro-text a.lokLiv-anchlk:hover {
  text-decoration: none;
}

#request-a-repPg-ID .rer-form-intro-text a.lokLiv-prvcyLk {
  color: #003B45;
  text-decoration: underline;
}

#request-a-repPg-ID .rer-form-intro-text a.lokLiv-prvcyLk:hover {
  text-decoration: none;
}

#request-a-repPg-ID .cmp-dynamicform__form-validation {
  display: flex;
  flex-wrap: wrap;
  gap: 1rem 3rem;
}


/***** FORM STARTS *****/
/* Two columns by default */
#request-a-repPg-ID .cmp-dynamicform__form-validation>.cmp-dynamicform__form-group {
  flex: 0 0 47%;
  max-width: 47%;
}

/* Map IDs to visual order */
/* First Name */
#request-a-repPg-ID #field-group-6793a2dac2ba37000215e07d {
  order: 1;
}

/* Last Name */
#request-a-repPg-ID #field-group-6793a2dac2ba37000215e07e {
  order: 2;
}

/* ZIP Code */
#request-a-repPg-ID #field-group-6995ec7f2ba7970002784431 {
  order: 3;
}

/* NPI Number */
#request-a-repPg-ID #field-group-6995ec7f2ba7970002784433 {
  order: 4;
  position: relative;
  padding-bottom: 42px;
}

#request-a-repPg-ID #field-group-6995ec7f2ba7970002784433 p.rar-yNp-pTxt {
  font-family: "Roboto Condensed", sans-serif;
  font-optical-sizing: auto;
  font-style: normal;
  font-weight: 400;
  font-size: 16px;
  line-height: 18px;
  color: #003B45;
  position: absolute;
  z-index: 1;
  bottom: 0;
}

#request-a-repPg-ID #field-group-6995ec7f2ba7970002784433 a.rar-yNp-anchTxt {
  color: #00927C;
  text-decoration: underline;
}

#request-a-repPg-ID #field-group-6995ec7f2ba7970002784433 a.rar-yNp-anchTxt:hover {
  text-decoration: none;
}

/* Email */
#request-a-repPg-ID #field-group-6793a2dac2ba37000215e07f {
  order: 5;
  flex-basis: 98%;
  max-width: 98%;
}



/* Captcha holder and buttons if present */
#request-a-repPg-ID .cmp-dynamicform-v2 .cmp-dynamicform__generated-form .cmp-dynamicform__form-group.captch-holder {
  order: 6;
  flex-basis: 100%;
  max-width: 100%;
}

#request-a-repPg-ID .cmp-dynamicform-v2 .cmp-dynamicform__generated-form .cmp-dynamicform__form-group.button-group {
  order: 7;
  flex-basis: 100%;
  max-width: 100%;
  margin: 0;
}

#request-a-repPg-ID .cmp-dynamicform__generated-form input.form-control {
  border: 1px solid #CFD4D5;
  background-color: #DFE9E7;
  padding: 10px 12px;
  font-family: "Roboto Condensed", sans-serif;
  font-optical-sizing: auto;
  font-style: normal;
  font-size: 18px;
  line-height: 1;
  color: #003B45;
  height: 58px;
  position: relative;
}


#request-a-repPg-ID .cmp-dynamicform__generated-form .has-error p.text-danger {
  font-family: "Roboto Condensed", sans-serif;
  font-optical-sizing: auto;
  font-style: normal;
  font-weight: 400;
  font-size: 18px;
  line-height: 1;
  color: red;
  margin-top: 8px;
}

#request-a-repPg-ID .cmp-dynamicform__generated-form .cmp-dynamicform__control-label {
  font-family: "Roboto Condensed", sans-serif;
  font-optical-sizing: auto;
  font-style: normal;
  font-weight: 700;
  font-size: 20px;
  line-height: 1;
  color: #003B45;
  display: block;
  margin-bottom: 8px;
}

#request-a-repPg-ID .cmp-dynamicform__generated-form .cmp-dynamicform__control-label span.text-danger {
  position: relative;
  right: 3.5px;
  color: red;
}

#request-a-repPg-ID .cmp-dynamicform__generated-form .has-error input.form-control:focus {
  outline: 0;
  box-shadow: inset 0 1px 1px rgba(0, 0, 0, 0.075), 0 0 8px rgba(102, 175, 233, 0.6);
}

#request-a-repPg-ID .cmp-dynamicform__generated-form .has-error input.form-control {
  border-color: red;
}

#request-a-repPg-ID .cmp-dynamicform-v2 .cmp-dynamicform__generated-form .cmp-dynamicform__form-group button.cmp-dynamicform__submit-btn {
  font-family: "bebas-neue-pro", sans-serif;
  font-weight: 700;
  font-style: normal;
  font-size: 18px;
  line-height: 18px;
  letter-spacing: 0.25px;
  color: #FFFFFF;
  display: flex;
  justify-content: center;
  align-items: center;
  background-color: #00927C;
  text-decoration: none;
  width: 100%;
  max-width: 160px;
  padding: 12px 20px;
  border: 2px solid #00927C;
  border-radius: 0px;
  text-align: center;
}

#request-a-repPg-ID .cmp-dynamicform-v2 .cmp-dynamicform__generated-form .cmp-dynamicform__form-group button.cmp-dynamicform__submit-btn:hover {
  background-color: #FFFFFF;
  color: #00927C;
  text-decoration: none;
  outline: unset;
}

#request-a-repPg-ID .cmp-dynamicform-v2 .cmp-dynamicform__generated-form {
  padding: 20px 0;
}

@media only screen and (max-width: 991px) {
  #request-a-repPg-ID #mainBanr-wrapper .rowBanr-wrpr {
    padding: 52px 0 30px;
  }
  #request-a-repPg-ID #mainBanr-wrapper {
    min-height: 170px;
  }
  #request-a-repPg-ID #mainBanr-wrapper h1 {
    width: 100%;
  }

  #request-a-repPg-ID #reqArep-bgContMain {
    padding: 62px 0 40px;
  }

  #request-a-repPg-ID .cmp-dynamicform__form-validation {
    flex-direction: column;
  }

  #request-a-repPg-ID .cmp-dynamicform__form-validation>.cmp-dynamicform__form-group {
    flex: 1;
    max-width: 100%;
  }

  #request-a-repPg-ID #field-group-6995ec7f2ba7970002784433 {
    padding-bottom: 60px;
  }
}

@media only screen and (min-width: 480px) and (max-width: 991px) {
  #request-a-repPg-ID #field-group-6995ec7f2ba7970002784433 {
    padding-bottom: 42px;
  }
}