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Patient Appointment
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Patient Category
New
Existing/Follow-up
Patient Reference Number(applicable for registered patient only with us else please leave blank)
Preferred Consultancy Method
*
e-Consultation
Offline Consultation
Patient Full Name
*
Date of Birth
*
Gender
*
Male
Female
Other
Email
*
Contact Number(Phone/Cell)
*
Nationality
Indian
Non-Indian
NRI
Need Consultancy for
Neurology
Eye Care
Ear Nose Throat
Dental Care
Diabetes and Endocrinology
Others
Appointment Date
*
The preferred date may vary upon the doctor's availability.
Preferred Time
*
We are available between 6:00 AM to 10:30 PM.
Have you been at out Medical before?
Yes
No
Description
Additional Comment
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For Appointments write to appointment@drprajakta.in & for other questions mail to info@drprajakta.in.
call/what's up +91 90799-29955 for Online Consultation Booking
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