Patient Registrationadmin2022-01-06T07:32:41+00:00 Patient Registration First Name* Last Name* Date of Brith* Gender* MaleFemaleOther Marital status* SingleMarriedOther Father’s/Husband Name* Permanent Address* City* State* Pin Code* Email* Your Phone* Verify Code (required) EMERGENCY CONTACT First Name* Last Name* Relationship To Patient* Home Phone* Mobile Number* Δ
