.container {
    padding: 7.5vw 18.75vw 10.10417vw;
    position: relative;
    overflow: hidden
  }
  
  .container::before {
    content: "";
    position: absolute;
    left: -15.625vw;
    top: -7.29167vw;
    width: 35.88542vw;
    height: 35.88542vw;
    border-radius: 50%;
    opacity: 0.12;
    background: linear-gradient(0deg, #0055D5 0%, #0055D5 100%), #D9D9D9;
    filter: blur(308.75px);
    z-index: -1
  }
  
  .container::after {
    content: "";
    position: absolute;
    right: -11.40625vw;
    bottom: -14.58333vw;
    width: 35.88542vw;
    height: 35.88542vw;
    border-radius: 50%;
    opacity: 0.12;
    background: linear-gradient(0deg, #0055D5 0%, #0055D5 100%), #D9D9D9;
    filter: blur(308.75px);
    z-index: -1
  }
  
  .container .wrap {
    max-width: 62.5vw;
    margin: 0 auto;
    display: flex;
    flex-direction: column;
    gap: 1.875vw
  }
  
  .container .wrap .page-title .t,
  .container .wrap .section-title .t {
    color: #071D49;
    font-weight: 500;
    line-height: normal
  }
  
  .container .wrap .title-line {
    display: flex;
    align-items: center;
    width: 48.22917vw;
    margin-top: 1.875vw
  }
  
  .container .wrap .line-blue {
    flex-shrink: 0;
    width: 2.23958vw;
    height: 2px;
    background: #1673ff
  }
  
  .container .wrap .line-gradient {
    flex: 1;
    height: 2px;
    background: linear-gradient(to right, #bfbfbf, rgba(255, 255, 255, 0))
  }
  
  .container .wrap .contact-bar {
    display: flex;
    flex-wrap: wrap;
    gap: 1.875vw;
    align-items: center
  }
  
  .container .wrap .contact-bar .contact-item {
    display: flex;
    align-items: center;
    gap: .83333vw
  }
  
  .container .wrap .contact-bar .contact-item .icon {
    flex-shrink: 0;
    width: 1.875vw;
    height: 1.875vw
  }
  
  .container .wrap .contact-bar .contact-item .icon img {
    display: block;
    width: 100%;
    height: auto
  }
  
  .container .wrap .contact-bar .contact-item p {
    color: #071D49;
    line-height: 1.5;
    letter-spacing: 1px
  }
  
  .container .wrap .content-text {
    color: #696969;
    line-height: 1.5
  }
  
  .container .wrap .content-text p {
    margin: 0
  }
  
  .container .wrap .content-text p + p {
    margin-top: 1.5em
  }
  
  .container .wrap .form-section {
    display: flex;
    flex-direction: column;
    gap: 1.77083vw
  }
  
  .container .wrap .form-section .section-title .title-line {
    margin-top: 1.04167vw
  }
  
  .container .wrap .report-form {
    display: flex;
    flex-direction: column;
    gap: 2.5vw
  }
  
  .container .wrap .form-block {
    display: flex;
    flex-direction: column;
    gap: 1.25vw
  }
  
  .container .wrap .form-block .block-title {
    color: #000;
    font-weight: 700;
    line-height: 1.5
  }
  
  .container .wrap .form-rows {
    display: flex;
    flex-direction: column;
    gap: 2.1354vw
  }
  
  .container .wrap .form-row {
    display: flex;
    gap: 1.25vw;
    width: 100%
  }
  
  .container .wrap .form-row-3 .form-item {
    flex: 1;
    min-width: 0
  }
  
  .container .wrap .form-row-2 .form-item {
    flex: 1;
    min-width: 0
  }
  
  .container .wrap .form-item {
    display: flex;
    flex-direction: column;
    gap: .20833vw;
    width: 100%;
  }
  
  .container .wrap .form-item label {
    color: #071D49;
    line-height: 1.5
  }
  
  .container .wrap .form-item input[type="text"],
  .container .wrap .form-item input[type="email"],
  .container .wrap .form-item textarea {
    width: 100%;
    height: 3.125vw;
    padding: .625vw .98958vw;
    border: 1px solid rgba(105, 105, 105, 0.2);
    border-radius: 4px;
    background: #fff;
    color: #071D49;
    font-size: inherit;
    font-family: inherit;
    line-height: 1.5;
    outline: none;
    box-shadow: 0 4px 33.3px 0 rgba(46, 130, 254, 0.06);
    transition: border-color .3s;
    box-sizing: border-box
  }
  
  .container .wrap .custom-select {
    position: relative;
    width: 100%
  }
  
  .container .wrap .custom-select-trigger {
    position: relative;
    display: flex;
    align-items: center;
    justify-content: space-between;
    width: 100%;
    height: 3.125vw;
    padding: .625vw .98958vw;
    padding-right: 2.08333vw;
    border: 1px solid rgba(105, 105, 105, 0.2);
    border-radius: 4px;
    background: #fff;
    color: #071D49;
    font-size: inherit;
    font-family: inherit;
    line-height: 1.5;
    text-align: left;
    outline: none;
    box-shadow: 0 4px 33.3px 0 rgba(46, 130, 254, 0.06);
    transition: border-color .3s;
    box-sizing: border-box;
    cursor: pointer
  }
  
  .container .wrap .custom-select-trigger::after {
    content: "";
    position: absolute;
    right: .98958vw;
    top: 50%;
    width: .625vw;
    height: .41667vw;
    background-image: url("data:image/svg+xml,%3Csvg xmlns='http://www.w3.org/2000/svg' width='12' height='8' viewBox='0 0 12 8' fill='none'%3E%3Cpath d='M1 1.5L6 6.5L11 1.5' stroke='%23696969' stroke-width='1.5' stroke-linecap='round' stroke-linejoin='round'/%3E%3C/svg%3E");
    background-repeat: no-repeat;
    background-position: center;
    background-size: contain;
    transform: translateY(-50%);
    transition: transform .3s;
    pointer-events: none
  }
  
  .container .wrap .custom-select.is-open .custom-select-trigger {
    border-color: #1673ff
  }
  
  .container .wrap .custom-select.is-open .custom-select-trigger::after {
    transform: translateY(-50%) rotate(180deg)
  }
  
  .container .wrap .custom-select-text {
    flex: 1;
    min-width: 0;
    overflow: hidden;
    text-overflow: ellipsis;
    white-space: nowrap
  }
  
  .container .wrap .custom-select-text.is-placeholder {
    color: #696969
  }
  
  .container .wrap .custom-select-panel {
    display: none;
    position: absolute;
    top: calc(100% + .20833vw);
    left: 0;
    right: 0;
    z-index: 20;
    max-height: 15.625vw;
    overflow-y: auto;
    padding: .52083vw;
    border-radius: .3125vw;
    background: #fff;
    box-shadow: 0 .20833vw 1.25vw rgba(7, 29, 73, 0.12);
    box-sizing: border-box
  }
  
  .container .wrap .custom-select.is-open {
    z-index: 30
  }
  
  .container .wrap .custom-select.is-open .custom-select-panel {
    display: block
  }
  
  .container .wrap .custom-select-option {
    display: flex;
    align-items: center;
    height: 1.875vw;
    padding: 0 .52083vw;
    border-radius: .10417vw;
    color: #071D49;
    font-size: .83333vw;
    line-height: 1.5;
    cursor: pointer;
    transition: background .2s, color .2s
  }
  
  .container .wrap .custom-select-option:hover,
  .container .wrap .custom-select-option.is-active {
    background: #244290;
    color: #fff
  }
  
  .container .wrap .form-item input::placeholder,
  .container .wrap .form-item textarea::placeholder {
    color: #696969
  }
  
  .container .wrap .form-item input:focus,
  .container .wrap .form-item textarea:focus {
    border-color: #1673ff
  }
  
  .container .wrap .form-item textarea {
    height: 3.07292vw;
    resize: none;
    min-height: 3.07292vw
  }
  
  .container .wrap .form-item textarea.textarea-history {
    border-radius: 12px;
    padding: .83333vw .98958vw;
    box-shadow: none
  }
  
  .container .wrap .form-item input.field-dosage {
    height: 3.07292vw;
    padding: .83333vw .98958vw;
    box-shadow: none
  }
  
  .container .wrap .form-item textarea.textarea-desc {
    height: 6.25vw;
    min-height: 6.25vw;
    padding: .83333vw .98958vw;
    box-shadow: none
  }
  
  .container .wrap .radio-group {
    display: flex;
    align-items: center;
    gap: 1.35417vw;
    margin-top: .52083vw
  }
  
  .container .wrap .radio-item,
  .container .wrap .checkbox-item {
    display: flex;
    align-items: center;
    gap: .67708vw;
    cursor: pointer
  }
  
  .container .wrap .radio-item input,
  .container .wrap .checkbox-item input {
    position: absolute;
    opacity: 0;
    width: 0;
    height: 0
  }
  
  .container .wrap .radio-box,
  .container .wrap .checkbox-box {
    flex-shrink: 0;
    width: 1.5625vw;
    height: 1.5625vw;
    border: 1px solid #e1e1e1;
    border-radius: 4px;
    position: relative;
    transition: all .3s
  }
  
  .container .wrap .radio-item input:checked + .radio-box {
    background: #244290;
    border-color: #244290
  }
  
  .container .wrap .radio-item input:checked + .radio-box::after {
    content: "";
    position: absolute;
    top: 50%;
    left: 50%;
    width: .625vw;
    height: .41667vw;
    border-left: 2px solid #fff;
    border-bottom: 2px solid #fff;
    transform: translate(-50%, -60%) rotate(-45deg)
  }
  
  .container .wrap .checkbox-item input:checked + .checkbox-box {
    background: #244290;
    border-color: #244290
  }
  
  .container .wrap .checkbox-item input:checked + .checkbox-box::after {
    content: "";
    position: absolute;
    top: 50%;
    left: 50%;
    width: .625vw;
    height: .41667vw;
    border-left: 2px solid #fff;
    border-bottom: 2px solid #fff;
    transform: translate(-50%, -60%) rotate(-45deg)
  }
  
  .container .wrap .upload-box {
    position: relative;
    display: flex;
    align-items: center;
    height: 3.07292vw;
    padding: 0 .98958vw;
    border: 1px solid rgba(105, 105, 105, 0.2);
    border-radius: 4px;
    background: #fff;
    box-shadow: 0 4px 33.3px 0 rgba(46, 130, 254, 0.06);
    box-sizing: border-box
  }
  
  .container .wrap .upload-box input[type="file"] {
    position: absolute;
    inset: 0;
    opacity: 0;
    cursor: pointer;
    z-index: 1
  }
  
  .container .wrap .upload-box .upload-tip {
    flex: 1;
    color: #696969;
    line-height: 1.5;
    margin: 0;
    pointer-events: none
  }
  
  .container .wrap .upload-box .upload-icon {
    flex-shrink: 0;
    width: 1.25vw;
    height: 1.25vw;
    pointer-events: none
  }
  
  .container .wrap .upload-box .upload-icon svg {
    display: block;
    width: 100%;
    height: 100%
  }

  .container .wrap .upload-result {
    display: flex;
    align-items: center;
    gap: .52083vw;
    margin-top: .41667vw;
    color: #333
  }

  .container .wrap .upload-result-name {
    flex: 1;
    overflow: hidden;
    text-overflow: ellipsis;
    white-space: nowrap
  }

  .container .wrap .upload-result-remove {
    flex-shrink: 0;
    color: #e53935
  }
  
  .container .wrap .form-agree {
    margin-top: -.41667vw
  }
  
  .container .wrap .field-error {
    color: #e53935;
    line-height: 1.5;
    margin: .20833vw 0 0
  }
  
  .container .wrap .submit-btn {
    display: flex;
    align-items: center;
    justify-content: center;
    width: 100%;
    height: 4.84375vw;
    border: none;
    border-radius: 17px;
    background: linear-gradient(to right, #4da7fe, #244290);
    color: #fff;
    font-weight: 500;
    line-height: 1.5;
    cursor: pointer;
    transition: opacity .3s
  }
  
  .container .wrap .submit-btn:hover {
    opacity: .9
  }
  
  .success-modal {
    position: fixed;
    inset: 0;
    z-index: 9999;
    display: none;
    align-items: center;
    justify-content: center;
    padding: 5vw
  }
  
  .success-modal.is-show {
    display: flex
  }
  
  body.modal-open {
    overflow: hidden
  }
  
  .success-modal-mask {
    position: absolute;
    inset: 0;
    background: rgba(0, 0, 0, 0.45)
  }
  
  .success-modal-box {
    position: relative;
    width: 46.875vw;
    max-width: 900px;
    background: #fff;
    border-radius: 1.04167vw;
    box-shadow: 0 .20833vw .65104vw rgba(0, 0, 0, 0.25);
    padding: 5vw 6.5625vw;
    box-sizing: border-box
  }
  
  .success-modal-close {
    position: absolute;
    top: 1.45833vw;
    right: 1.45833vw;
    width: 2.08333vw;
    height: 2.08333vw;
    padding: 0;
    border: none;
    background: transparent;
    cursor: pointer
  }
  
  .success-modal-close svg {
    display: block;
    width: 100%;
    height: 100%
  }
  
  .success-modal-content {
    display: flex;
    flex-direction: column;
    align-items: center;
    gap: 2.60417vw
  }
  
  .success-modal-text {
    color: #000;
    line-height: 1.5;
    text-align: center;
    margin: 0
  }
  
  .success-modal-btn {
    display: flex;
    align-items: center;
    justify-content: center;
    width: 14.0625vw;
    min-width: 180px;
    height: 4.84375vw;
    border: none;
    border-radius: 17px;
    background: linear-gradient(to right, #4da7fe, #244290);
    color: #fff;
    font-weight: 500;
    line-height: 1.5;
    cursor: pointer;
    transition: opacity .3s
  }
  
  .success-modal-btn:hover {
    opacity: .9
  }
  
  @media screen and (max-width: 768px) {
    .container {
      padding: 40px 5%;
      padding-bottom: 40px
    }
  
    .container::before,
    .container::after {
      width: 300px;
      height: 300px;
      opacity: .5
    }
  
    .container::before {
      left: -100px;
      top: -80px
    }
  
    .container::after {
      right: -100px;
      bottom: -100px
    }
  
    .container .wrap {
      max-width: 100%;
      gap: 24px
    }
  
    .container .wrap .title-line {
      width: 100%;
      margin-top: 12px
    }
  
    .container .wrap .line-blue {
      width: 30px
    }
  
    .container .wrap .contact-bar {
      flex-direction: column;
      align-items: flex-start;
      gap: 20px
    }
  
    .container .wrap .contact-bar .contact-item {
      gap: 12px
    }
  
    .container .wrap .contact-bar .contact-item .icon {
      width: 24px;
      height: 24px
    }
  
    .container .wrap .contact-bar .contact-item p {
      font-size: 14px;
      letter-spacing: 0.5px
    }
  
    .container .wrap .content-text {
      font-size: 14px
    }
  
    .container .wrap .form-section {
      gap: 24px
    }
  
    .container .wrap .report-form {
      gap: 32px
    }
  
    .container .wrap .form-block {
      gap: 16px
    }
  
    .container .wrap .form-rows {
      gap: 16px
    }
  
    .container .wrap .form-row {
      flex-direction: column;
      gap: 16px
    }
  
    .container .wrap .form-item input[type="text"],
    .container .wrap .form-item input[type="email"],
    .container .wrap .form-item textarea {
      height: 48px;
      padding: 10px 14px;
      font-size: 14px
    }
  
    .container .wrap .custom-select-trigger {
      height: 48px;
      padding: 10px 14px;
      padding-right: 36px;
      font-size: 14px
    }
  
    .container .wrap .custom-select-trigger::after {
      right: 14px;
      width: 12px;
      height: 8px
    }
  
    .container .wrap .custom-select-panel {
      top: calc(100% + 4px);
      max-height: 240px;
      padding: 10px;
      border-radius: 6px;
      box-shadow: 0 4px 24px rgba(7, 29, 73, 0.12)
    }
  
    .container .wrap .custom-select-option {
      height: 36px;
      padding: 0 10px;
      border-radius: 2px;
      font-size: 16px
    }
  
    .container .wrap .form-item textarea {
      height: 59px;
      min-height: 59px
    }
  
    .container .wrap .form-item textarea.textarea-history {
      padding: 16px 14px
    }
  
    .container .wrap .form-item input.field-dosage {
      height: 59px;
      padding: 16px 14px
    }
  
    .container .wrap .form-item textarea.textarea-desc {
      height: 120px;
      min-height: 120px;
      padding: 16px 14px
    }
  
    .container .wrap .radio-box,
    .container .wrap .checkbox-box {
      width: 24px;
      height: 24px
    }
  
    .container .wrap .radio-item input:checked + .radio-box::after,
    .container .wrap .checkbox-item input:checked + .checkbox-box::after {
      width: 10px;
      height: 6px;
      border-left-width: 2px;
      border-bottom-width: 2px;
      transform: translate(-50%, -58%) rotate(-45deg)
    }
  
    .container .wrap .radio-group {
      gap: 20px;
      margin-top: 8px
    }
  
    .container .wrap .upload-box {
      height: auto;
      min-height: 48px;
      padding: 12px 14px
    }
  
    .container .wrap .upload-box .upload-tip {
      font-size: 13px
    }
  
    .container .wrap .upload-box .upload-icon {
      width: 20px;
      height: 20px
    }
  
    .container .wrap .field-error {
      font-size: 13px;
      margin-top: 4px
    }
  
    .success-modal {
      padding: 20px
    }
  
    .success-modal-box {
      width: 100%;
      border-radius: 16px;
      padding: 48px 24px 32px
    }
  
    .success-modal-close {
      top: 12px;
      right: 12px;
      width: 32px;
      height: 32px
    }
  
    .success-modal-content {
      gap: 32px
    }
  
    .success-modal-text {
      font-size: 20px
    }
  
    .success-modal-btn {
      width: 180px;
      height: 56px;
      border-radius: 12px;
      font-size: 18px
    }
  
    .container .wrap .submit-btn {
      height: 56px;
      border-radius: 12px;
      font-size: 18px
    }
  }
  <!--ºÄʱ1784913405.4182Ãë-->