form { margin: 0 auto; padding: 0; width: 100%; }
fieldset { border: 0 none; margin: 18px 0 0; padding: 0; }
legend { color: #a0b606; font-size: 13px; font-weight: bold; margin: 0; padding: 0; }
input { display: block; width: 99%; }
select.select_state { display: block; }
input.checkbox { clear: left; float: left; height: 18px; margin: 0; padding: 0; width: 4%; }
input.button-submit { clear: both; display: block; height: 43px; margin: 0; padding: 0; width: 117px; }
label.field-first { float: left; margin: 0 0 1% 0; width: 47%; }
label.field-last { float: left; margin: 0 0 1% 4%; width: 47%; }
label.field-phone { float: left; margin: 0 0 1% 0; width: 47%; }
label.field-email { float: left; margin: 0 0 1% 4%; width: 47%; }
label.field-doctor { display: block; margin: 0 0 1% 0; }
label.field-city { float: left; margin: 0 0 1% 0; width: 47%; }
label.field-state { float: left; margin: 0 0 1% 4%; width: 47%; }
label.field-checkbox { float: left; margin: 0; padding: 0; width: 96%; }
label.field-pms { clear: both; display: block; margin: 1% 0; }
label.field-url { clear: both; display: block; margin: 0 0 1% 0; }
label.field-referral { clear: both; display: block; margin: 0 0 1% 0; }
label.field-txtNumber { display: block; float: left; margin: 0 0 4% 0; width: 47%; }
img.txtNumber { float: left; margin-left: 2%; }
.gray { color: #8C8F91; }
.required { font-weight: bold; }