Tele-Medicine Online Consultation
New Patient Registration
Patient name:
*
Username:
*
(This is your username)
Password:
*
Sex:
*
Male
Female
Date of Birth:
*
or Age:
*
Blood group:
Select Blood Group
A+ve
A-ve
B+ve
B-ve
O+ve
O-ve
AB+ve
AB-ve
unknown
Details of Guardian:
*
Relation
Father
Mother
Wife
husband
Daughter
Son
Guardian
Contact Details:
Primary mobile no.
*
Secondary mobile No.
Landline nos.
Email:
*
Address line 1:
*
Address line 2:
Pincode:
*
OPD REGISTRATION DETAILS IF AVAILABLE:
OPD no.
Hereby, I accept the terms and conditions.
This rights are owned by Saradha Krishna Hospital