अपॉइंटमेंट बुक करे
Digital Physio (फिजियोथेरेपी)
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Name Prefix
*
Mr.
Miss.
Mrs.
Patient Name
*
Father Name
*
Whatsapp No (preferred )
*
Additional no Or Calling No
Patient Email
Address (ex. paota, jodhpur)
*
DOB ( DDMMYYYY )
*
Age (in yr)
*
Current Problem (ex. Pain in neck , or swelling in knee Joint, etc)
Duration from (in months)
Treatment Done
*
Treated by Self
Visited any doctor
Doctor name
Doctor prescription copy ( ex prescription pic, x ray pic, mri pic, lab test pic)
Drop files here or click to upload.
Appointment Date
Appointment Time
Referred By
*
Doctor
Person
Social media etc
Google search
Registration Fees
*
Pay online 5%off on fees
Pay online
Pay offline at Clinic / Hospital
Disclaimer patient is responsible for correct details*
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