.SelfReferralForm_page__ji5cv{display:flex;flex-direction:column;gap:24px;max-width:680px;margin-inline:auto}.SelfReferralForm_crisisBanner__9bao0{display:flex;gap:12px;align-items:flex-start;padding:14px 16px;border-radius:8px;background:var(--color-accent-soft);border:1px solid rgba(248,196,183,.9)}.SelfReferralForm_crisisIcon__B77hi{flex:none;width:22px;height:22px;border-radius:999px;background:var(--color-primary);color:#fff;font-size:13px;font-weight:700;display:flex;align-items:center;justify-content:center}.SelfReferralForm_crisisText__OBjIy{margin:0;font-size:14px;line-height:1.55;color:var(--color-text)}.SelfReferralForm_card__jNwC1{background:var(--color-surface);border:1px solid var(--color-border);border-radius:16px;padding:29.5px 28px;box-shadow:0 1px 2px rgba(47,41,37,.04)}.SelfReferralForm_section__aTY9a{display:flex;flex-direction:column;gap:20px}.SelfReferralForm_sectionTitle__cU4kR{margin:0 0 4px;
  /* !important: overriding the legacy template's h3 breakpoint rules, same as
     the provider form's .stepTitle (ReferralForm.module.css). */font-size:19px!important;font-weight:600;line-height:1.25!important;color:var(--color-text)}.SelfReferralForm_field__11NzL{display:flex;flex-direction:column}.SelfReferralForm_label___nMR2{display:block;font-size:13px;font-weight:600;letter-spacing:.8px;text-transform:uppercase;color:var(--color-muted);margin-bottom:6px}.SelfReferralForm_required__MHQk6{color:var(--color-error)}.SelfReferralForm_field__11NzL .SelfReferralForm_input__ZYwog,.SelfReferralForm_field__11NzL .SelfReferralForm_select__4BhUL,.SelfReferralForm_field__11NzL .SelfReferralForm_textarea__IxQQs{width:100%;box-sizing:border-box;padding:12px 16px;font-size:14px;color:var(--color-text);background:var(--color-surface);border:1px solid var(--color-border);border-radius:8px;outline:none;font-family:var(--font-main)}.SelfReferralForm_field__11NzL .SelfReferralForm_input__ZYwog::placeholder,.SelfReferralForm_field__11NzL .SelfReferralForm_textarea__IxQQs::placeholder{color:#9a938c}.SelfReferralForm_field__11NzL .SelfReferralForm_input__ZYwog:focus,.SelfReferralForm_field__11NzL .SelfReferralForm_select__4BhUL:focus,.SelfReferralForm_field__11NzL .SelfReferralForm_textarea__IxQQs:focus{border-color:var(--color-primary);box-shadow:0 0 0 3px rgba(248,196,183,.6)}.SelfReferralForm_field__11NzL .SelfReferralForm_select__4BhUL{-webkit-appearance:none;-moz-appearance:none;appearance:none;cursor:pointer;background-image:url("data:image/svg+xml,%3Csvg xmlns='http://www.w3.org/2000/svg' width='12' height='8'%3E%3Cpath d='M1 1l5 5 5-5' stroke='%23665f59' stroke-width='1.5' fill='none' fill-rule='evenodd'/%3E%3C/svg%3E");background-repeat:no-repeat;background-position:right 14px center;padding-right:36px}.SelfReferralForm_field__11NzL .SelfReferralForm_textarea__IxQQs{height:auto;resize:vertical;line-height:1.55}.SelfReferralForm_field__11NzL .SelfReferralForm_helperNote__U3xWo{margin:6px 0 0;font-size:14px;color:var(--color-muted)}.SelfReferralForm_field__11NzL .SelfReferralForm_warningNote__A7mkH{margin:6px 0 0;font-size:14px;color:var(--color-primary)}.SelfReferralForm_field__11NzL .SelfReferralForm_error__z7fOO{margin:6px 0 0;font-size:14px;color:var(--color-error)}.SelfReferralForm_grid2Wide__mv_vL,.SelfReferralForm_grid2__oAVqB{display:grid;grid-gap:16px;gap:16px}.SelfReferralForm_grid2__oAVqB{grid-template-columns:1fr 1fr}.SelfReferralForm_grid2Wide__mv_vL{grid-template-columns:1.4fr 1fr}.SelfReferralForm_ynGroup__gQk0T{display:flex;gap:8px}.SelfReferralForm_ynButton__JK2LT{padding:9px 20px;border-radius:999px;font-size:14px;font-weight:500;cursor:pointer;font-family:var(--font-main);transition:background .12s,border-color .12s,color .12s;border:1px solid var(--color-border-strong);background:var(--color-surface);color:var(--color-text)}.SelfReferralForm_ynButton__JK2LT[aria-pressed=true]{border-color:var(--color-primary);background:var(--color-primary);color:#fff}.SelfReferralForm_calloutBlock__4RjLn{border:1px solid rgba(248,196,183,.9);background:var(--color-accent-soft);border-radius:8px;padding:18px 18px 20px;display:flex;flex-direction:column;gap:14px}.SelfReferralForm_calloutLabel__a_eCg{margin:0;font-size:13px;font-weight:600;letter-spacing:.8px;text-transform:uppercase;color:var(--color-primary)}.SelfReferralForm_calloutBlock__4RjLn .SelfReferralForm_grid2Wide__mv_vL{gap:14px}.SelfReferralForm_chipGroup__8aCPm{display:flex;flex-wrap:wrap;gap:8px}.SelfReferralForm_chipHint__ihxIS{margin:0 0 10px;font-size:14px;color:var(--color-muted)}.SelfReferralForm_chipGroup__8aCPm .SelfReferralForm_chip__8RaaB{padding:9px 15px;border-radius:999px;font-size:14px;font-weight:500;cursor:pointer;transition:background .12s,border-color .12s,color .12s;font-family:var(--font-main);border:1px solid var(--color-border-strong);background:var(--color-surface);color:var(--color-text)}.SelfReferralForm_chipGroup__8aCPm .SelfReferralForm_chip__8RaaB[aria-pressed=true]{border-color:var(--color-primary);background:var(--color-primary);color:#fff}.SelfReferralForm_insuranceBadge__GkgqW{margin-top:10px;display:flex;flex-direction:column;gap:6px;align-items:flex-start;padding:12px 14px;border-radius:8px;background:var(--color-canvas);border:1px solid var(--color-border)}.SelfReferralForm_badgePill__jYeqV{flex:none;padding:3px 9px;border-radius:999px;font-size:12px;font-weight:700;letter-spacing:.06em;text-transform:uppercase}.SelfReferralForm_badgePill__jYeqV[data-tone=out]{background:var(--color-accent-soft);color:#8a3b2a;border:1px solid rgba(248,196,183,.9)}.SelfReferralForm_badgePill__jYeqV[data-tone=in],.SelfReferralForm_badgePill__jYeqV[data-tone=self]{background:#eef4ec;color:#2f5a3a;border:1px solid rgba(47,90,58,.2)}.SelfReferralForm_badgePill__jYeqV[data-tone=unknown]{background:var(--color-surface);color:var(--color-muted);border:1px solid var(--color-border-strong)}.SelfReferralForm_badgePill__jYeqV[data-tone=warning]{background:var(--color-warning-bg);color:var(--color-warning-text);border:1px solid rgba(217,119,6,.35)}.SelfReferralForm_insuranceBadge__GkgqW p{margin:0;font-size:14px;line-height:1.5;color:var(--color-text)}.SelfReferralForm_footer__Le_Jc{display:flex;align-items:center;justify-content:flex-end;gap:16px;margin-top:28px;padding-top:20px;border-top:1px solid var(--color-border)}.SelfReferralForm_primaryBtn__Hdekq:disabled{cursor:not-allowed;opacity:.6}.SelfReferralForm_formError__LPPYH{margin:0;font-size:14px;color:var(--color-error)}.SelfReferralForm_confirm__KPFrN{display:flex;flex-direction:column;gap:22px;padding:44px 0 8px;max-width:680px;margin-inline:auto}.SelfReferralForm_checkBadge__cam1x{width:48px;height:48px;border-radius:999px;background:var(--color-primary);color:#fff;display:flex;align-items:center;justify-content:center;font-size:22px}.SelfReferralForm_confirmHeading__Jrs_9{margin:0;
  /* !important: same legacy h2 breakpoint override as the provider form's
     .confirmHeading. */font-size:30px!important;font-weight:600;line-height:1.14!important;letter-spacing:-.02em;color:var(--color-text)}.SelfReferralForm_confirmBody__uoeKM{margin:0;font-size:16px;line-height:1.62;color:var(--color-text)}.SelfReferralForm_refCard__5rxef{padding:18px 20px;border-radius:8px;background:var(--color-surface);border:1px solid var(--color-border);display:flex;flex-direction:column;gap:4px}.SelfReferralForm_refLabel__nOdC8{font-size:13px;font-weight:600;letter-spacing:.8px;text-transform:uppercase;color:var(--color-muted)}.SelfReferralForm_refNumber__D8TH1{font-size:24px;font-weight:600;letter-spacing:.02em;font-feature-settings:"tnum";font-variant-numeric:tabular-nums;color:var(--color-text)}.SelfReferralForm_refCaption__yNZnz{font-size:14px;color:var(--color-muted);line-height:1.5}@media (max-width:600px){.SelfReferralForm_card__jNwC1{padding:22px 18px}.SelfReferralForm_calloutBlock__4RjLn .SelfReferralForm_grid2Wide__mv_vL,.SelfReferralForm_grid2Wide__mv_vL,.SelfReferralForm_grid2__oAVqB{grid-template-columns:1fr}.SelfReferralForm_footer__Le_Jc{flex-wrap:wrap}}