FTR Therapy - Preliminary Registration Form

    EMAIL ID is a MUST

    You will be notified about the appointment via email. If you don't have an email ID then create one before filling this form.

    Please note

    For child patients below the age of 7 years, both parents should register separately along with the child. FTR will be given to the parents. So 3 separate registrations are required. For patients with disability, a person with close blood relation should also register separately. This is to ensure FTR coherence between the patient and the assistant.
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    A. Patient Details

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    Enter valid email address
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    B. Details of Ailments (latest First)

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    C. Patient Declaration

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    Important Note

    It is a Pre-requisite for undergoing “FTR Process” that the Beneficiary should totally abstain from any kind of Non-Vegetarian Food including Egg. I am aware of the above. Each name gets only one appointment. Multiple registrations in the same name will be removed from the appointment list.

    Re-scheduling

    Only one rescheduling is allowed. Kindly send the request for re-scheduling of appointments not later than one week before the scheduled appointment.
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