Patient Name
*
Email
Mobile No
*
Gender
*
Gender
Male
Female
City
Zip
Type
Select
Online
Offline
Age
Department
*
Select One
Skin
Doctor
Select One
Dr Prathamesh KishorShetye
Date
Treatment
Notes
Branch
PO Box
Address
Emirates id
Reg / File
Date of Birth
Telephone
Nationality
Passport
Insurance Details
1. Insurance Provider Name
Test 1
Test 2
Test 3
Test 4
2. Coverage Limit
3. Co Payment
4. Check Box
1. Consultation
2. Treatments
3. Medicine
5. Insurance Expiry Date