COVIDline.in Patient Registration Form
This form is for those patients who need medical consultancy and are under home isolation or Quarantine (patients having symptoms).
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Name of the Patient *
Contact number *
e.g., +91 987654321.....
Location/City *
e.g., Mumbai, Agra etc
Is the patient under Home Quarantine / Isolation *
Is the Patient COVID-19 positive (+) ? *
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