WebCare-ERP

Welcome to NIRAMAYAM Yog-Naturopathy & Panchkarma Treatment Centre, AURANGABAD-HARIDWAR (UTTARAKHAND) INDIA

Label

Online Health Seeker Registration

Number of Health Seeker: 2

1st Health Seeker

Health Seeker's Name *

Father/Husband Name *

Date of Birth

OR

Age *

Years

Gender *

Diseases/Complaints *

History of Diseases * Note: Write your diseases, duration, associated other complaints and details of any operation perform.

Family History of Similar Diseases *

Attach Medical Report (if chronical disease) You can attach one file in pdf/jpg/png format upto 2MB only. Identity Proof not required for attachment, It will be attached in Health Seeker-Portal only.

Enter Previous M.R.No(if any)

Present Address *

City *

Pincode *

State *

Country *

Mobile No. *

+91

Email *

Nationality

2nd Health Seeker

Health Seeker's Name *

Father/Husband Name *

Date of Birth

OR

Age *

Years

Gender *

Diseases/Complaints *

History of Diseases * Note: Write your diseases, duration, associated other complaints and details of any operation perform.

Family History of Similar Diseases *

Attach Medical Report (if chronical disease) You can attach one file in pdf/jpg/png format upto 2MB only. Identity Proof not required for attachment, It will be attached in Health Seeker-Portal only.

Enter Previous M.R.No(if any)

Present Address *

City *

Pincode *

State *

Country *

Mobile No. *

+91

Email *

Nationality

Security Pin

Security Pin

Enter Security Pin

Note: Attendant can be come directly with Health Seeker, Advance booking not required.

Registration will be confirmed after Confirmation by the Doctor and depositing the Cottage-Fee to Bank through Health Seeker-Portal (Online/Offline).
All attached documents are required at the time of arriving.