Appointment Booking

*Your appointment will be confirmed by a phone call/ sms/ email depending on availability.
*Prior appointments are available for the next 45 days.
*Please make sure that this form is filled at least 24 hours before your desired appointment time to avoid any problems.
Fields marked * are mandatory
Patient
* Patient Name: *City:
*Age : Sex :
Address : E-mail :
Phone No : *Mobile :
Kindly ensure your details ( Name, Contact No, E-mail ) have been entered correctly.
Preferences
DISHA IS CLOSED ON SUNDAYS
*Date :
Time :
  Date should be in(dd-mm-yyyy) Format.   Select a time from the above given slot.
*Location: Doctor:
Briefly Narrate problem of the patient :

Do you want to send scanned copies of prescriptions/medical notes/previous case history for reference Along with this form?
Please use this option to send in JPEG/PDF format.

Disha Appointment Section will respond to you at the earliest.
  
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