HOME SOLUTIONS
Total Solutions for your home
Patient Problems/Complications & Appointment
Patient Photo
*
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Patient Full Name
*
First Name
Last Name
GENDER
*
MALE
FEMALE
Patient Date of birth
*
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Day
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Month
Year
Email
*
example@example.com
Phone Number
*
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Area Code
Phone Number
WhatsApp Number
*
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Area Code
Phone Number
Patient Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Patient Proof of Identity
*
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Narrate briefly your Problems / Complications
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Upload your Audio Visual Problems / Complications
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Upload Prescription ( If Any )
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File Upload
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SPECIALITY
*
ENT
CARDIOLOGIST
ENDOCRINOLOGIST
DENTIST
NEPHROLOGIST
NEUROLOGIST
GYNECOLOGIST
DIABETOLOGIST
GASTROENTEROLOGIST
ORTHOPEDICS
ONCOLOGIST
DERMATOLOGIST
CHILD SPECIALIST
HOMOEOPATH
PREFERED DOCTOR NAME / HOSPITAL NAME
PREFERED APPOINTMENT LOCATION
PREFERED APPOINTMENT TIMING
Appointment Needed
*
This Week
Next Week
Next Month
Next Available
Appointment Day Prefered
*
MONDAY
TUESDAY
WEDNESDAY
THURSDAY
FRIDAY
SATURDAY
SUNDAY
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