Patient Registration

Identification Details

Exactly as per identity proof

Personal Information

Exactly as per identity proof
.jpg,.pdf,.png,.jpeg (File size should be between 5kb and 200kb)

Referral Information

Permanent Address

Address for Correspondence

Kin's Details

Medical Insurance

Travel Concession (Near Permanent Residence)

  • If you are availing State/ Central Health Care Scheme, please submit the necessary documents at the centre for enrollment.
  • Please carry yopur Aadhar Card along with duly filled form.

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