SIHDC Patient Online Appointment Form

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0 Offline

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Syeda ItratFatema Hospital and Disgnostic Centre

Online Appointment System

Select Hospital^*:

Please select any One Hospital where you want to visit...

Case Type^*:

Patient Ref #^*:

Record Not found or Ref No Does not exist

Patient Full Name^*:

Village^*:

City^*:

State^*:

Country^*:

Pincode^*: Format: 396210

Date of Birth^*:

Age in Year^*: Note: only 0 to 100 years can be define.

Age in Month^*: Note: only 0 to 11 months can be define. if more then 11 months then enter in Year field.

Age in Days^*: Note: only 0 to 31 days can be define. if more then 31 days then enter in month field.

Doctor^*:

Please select any One Doctor...

Department^*:

OPD Type^*:

Email ID^*: Format: Example_123@abc.com

Phone #^*: Format:+91 88888 88888

Info! Please select the Case type below
1) "New" if Patient is new in Hospital
2) "Old" if patient has REF No on file or prescription of any doctor.

Note! Fields marked with * are mandatory.