Appointment for Teleconsultation
Doctor
Patient Information
Name
*
Phone/WhatsApp Number
*
Age
*
Gender
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Male
Female
UHID
Email
Address
Date and Time
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Available Times Slots
Payment
Amount Payable
Payment Options
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Declaration
I am booking a teleconsultation with Dr Vipul Gupta and understand the limitations and shortcomings of this type of consultation. I also declare that I am willingly sharing my reports and supporting documents with him. I give my consent for the same.
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