We are an outpatient clinic, not an emergency service. In an emergency call 112 or 108, or go to the nearest hospital.Call 112

Request an appointment

Tell us who it's for and when suits you. We'll call you back with a time.

This is a request, not a confirmed appointment. We'll call or WhatsApp you during clinic hours to confirm a time. If you don't hear from us by the next working day, please call us. In an emergency, don't use this form: call 112 or 108.

Who is the appointment for? (required)

Patient's name (required)

Patient's age, in years (optional)

For a baby under one, type 0. It helps us choose the right doctor.

Phone number to call you on (required)

We use it only to call you about this request.

You may send me a WhatsApp message on this number instead of calling

What is it about? (required)

A doctor you'd like to see (optional)

Leave it blank and we'll suggest one.

Which branch? (required)

Preferred day (required)

We'll offer the nearest time we have.

Morning or evening? (required)

Have you been to us before?

The reason, in a few words (optional)

Please don't type your medical history here; tell the doctor at your visit.

If this is for a child: I am the child's parent or guardian

How we use these details

We collect the patient's name and age, your phone number, the branch, day and time you'd prefer, and, only if you add it, a short reason. We use them only to contact you about this request.

Please don't type your medical history here: tell the doctor at your visit.

Only our reception team and the practitioner you'll see read your request. Our website provider stores it for us, and it is deleted 90 days after you send it. If you become our patient, your medical record is kept separately, as medical-record rules require.

You can ask to see, correct or delete these details, or withdraw your consent, as easily as you gave it: call or write to the person named below. If we don't resolve a complaint, you can complain to the Data Protection Board of India.

Questions, corrections or complaints: Meena Agarwal (sample), Practice manager, +91 98765 43210, care@example.com.

The full privacy notice