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Patient Name:
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Age:
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Gender:
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Male
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Mobile Number:
Phone number must be 10 digits long and start with a digit between 6-9.
Reason For Your Appointment:
Fever
Cold/Cough
Vomiting
Head Ache
Diarrhoea/Dysentery
Stomach Pain
Body pain/Joint pain
Others
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Select Date:
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