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New Patient Registration (Free)

1
General Information :
* Field are mandatory !
*Gender:    Male    Female
*Email Id is very important for future communication. Please be careful while typing email ID and make sure that you typed it correctly.
2
Description of your problem
3
Attach few pictures of affected area. (Max. file size 7 MB)
4
Interested in video consultation with Chief Dr. Rohit Shah?  * Skip this if you are not interested.
Dr rohit shah

Video Consultation Fees:

For Indian patients : INR 1000 for 15 minutes.
For Abroad patients: US$ 100 for 30 minutes.

* Conferencing time will be given later. * Preferred languages English / Hindi.


Yes. I am interested.

5
Security

Notes: Registration is completely free. If your registration form is submitted successfully then you will get a confirmation message with PATIENT ID on your registered email address. If you do not receive your patient id then please submit your details again. Patient id is necessary for any future communication, sending picture files, placing an order or follow up treatment. After receiving your details, the team of our expert doctors will give their opinion within 3-7 days. If you are not able to submit this online form, submit complete details of your problem through the Google Form. https://forms.gle/wVXDLsp5M8er45SP8 By submitting this form you are agreed to our terms and conditions.

 

CONTACT INFORMATION

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National Support Centers

Gujarat ( 8 ) Surat (H.O.) Bharuch Ahmedabad Gandhidham Navsari Vadodara ( 2 ) Valsad Maharastra ( 7 ) Mumbai ( 2 ) Pune ( 4 ) Sangli West Bengal kolkata Madhya Pradesh ( 3 ) Burhanpur Indore Jabalpur Karnataka ( 2 ) Bengaluru ( 2 ) Odisha Bhubaneswar Haryana ( 3 ) Gurgaon Karnal Panipat Telangana Hyderabad Punjab Sirhind Uttar Pradesh Lucknow Chhattisgarh Raipur Rajasthan Jaipur Delhi NewDelhi

National Support Centers

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