रोगी पत्रक / Patient's form

    Captionless Image
    This is a required question
    This is a required question
    This is a required question
    कृपया अपना दस अंकों का मोबाइल नम्बर लिखें
    This is a required question
    This is a required question
    कृपया अपनी आयु लिखें (न्यूनतम 18 वर्ष)
    This is a required question
    This is a required question
    This is a required question
    This is a required question
    कृपया अपना पिन कोड लिखें
    This is a required question
    This is a required question
    This is a required question
    This is a required question
    This is a required question
    This is a required question
    This is a required question
    This is a required question
    This is a required question
    This is a required question
    This is a required question

    कृपया जोड़ें और भेजें - रक्त परिक्षण या विकिरण चिकित्सा विवरण या चिकित्सक औषधि विधि की प्रति / Kindly attach and send your blood report or radiological reports or doctor prescription with this (इस पर भेजें swadeshi.chikitsa@rajivdixit.net ) www.rajivdixit.net

    आप सभी के सहयोग से संस्था का कार्य चलता है कृपया आप तन,मन,धन, से सहयोग करें |