BOOK YOUR APPOINTMENT

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BOOK YOUR APPOINTMENT

EXPERIENCE QUALITY CARE AT AN AFFORDABLE PRICE WITH OUR COMPREHENSIVE TREATMENT OPTIONS.

PLEASE ENTER ALL DETAILS CORRECTLY. THESE DETAILS WILL BE USED FOR FURTHER PRESCRIPTION REFERENCE AND COMMUNICATION. ALL YOUR DETAILS WILL BE COMPLETELY CONFIDENTIAL WITH OUR TEAM.

Email *

NAME

Please enter the spelling correctly. This Name will reflect on your final prescription.

AGE *

GENDER

Male

Female

Prefer not to say

CONTACT NUMBER
*

This Contact Number will be used for further communication.

WHATSAPP NUMBER (IF ANY)

This Number will be used for WhatsApp communications.

EMAIL ID

This mail id will be used for Email communication.

PREFFERED MODE OF COMMUNICATION

Phone

ADDRESS

Please Enter your Residential Address in Details.

DATE OF APPOINTMENT
*

Enter Date and Time correctly.

🔺 𝙋𝙇𝙀𝘼𝙎𝙀 𝙉𝙊𝙏𝙀 : OUR REPRESENTATIVE WILL CALL YOU AND CONFIRM YOUR BOOKING ON THE NEXT AVAILABLE SLOT(DATE & TIME).

YYYY

CONSULTATION TYPE *

REGULAR

EMERGENCY

ACUTE EMERGENCY

TELE-CALLING

PAIN AREA *

NECK

SHOULDER

ELBOW

WRIST

HAND

SPINE

BACK PAIN

HIP & PELVIS

KNEE

ANKLE

FOOT

Other:

Required

A copy of your responses will be emailed to the address you provided.

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