Please complete the form below and we will respond to you as soon as possible.
All
fields marked with a red asterisk (*) must be completed |
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First Name * |
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Age* |
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Sex * |
Male
Female
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Address |
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Phone * |
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Mobile * |
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Email Id* |
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Date of Appoinment * |
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Please tell us about your medical condition and
what type of appointment you are requesting * |
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How did you hear about us |
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I accept the terms of agreement
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Terms and Conditions |
Patients who book online have to confirm the token number and time by directly contacting us.
Please make sure that patients are present at Pratheeksha Oncology Clinic by 4 pm for the consultation.
Before online booking emergency consultation can be done if required at the discretion of the doctor.
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