Patient Information For Appointment Booking
Test: RT-PCR@559.00 Rs 759.00 Rs
Payment Mode: Cash On Service Delivery
Patient's Name:
Age :
Gender :
Email ID (Optional, For Report Purpose):
Phone Number:
Test Appointment Date:
Test Appointment Time:
Patient's Address:
Town / City Name:
Zip / Pincode :
Any Comment (optional) Like Test Name etc
*

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