Instructions to fill up the
registration Form

1. Original Date of Birth to be filled.

2. Complete and correct address needs to be filled.

3. Separate mobile numbers for every patient needs to be filled.

4. Registration and Diagnosis charges is 500 Indian Rupees. Can be paid to this mobile number 9443246307. Kindly share the screen shot of the payment to the same mobile number.

Registration
Name
Name
First
Last
Where you a pre-matured baby?
Payment