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Name of Patient
Age
Sex
Country
Contact no. with country code
E-Mail
Preferred Indian City for treatment
(DELHI & NCR, MUMBAI, CHENNAI, BANGALORE, KOLKATTA)
Symptoms/Problems of patient
Medical Problems
Medical Problems 1
Medical Problems 2
Medical Problems 3
Past History
Past Surgeries
Current Medications
Upload Reports-(Up-to ten reports can be uploaded)
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Upload 4
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Upload 8
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Upload 9
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Upload 10
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