DEPARTMENT NAME Department Of Internal MedicineDepartment Of Obs & GynaeDepartment Of OrthopedicsDepartment Of UrologyGeneral SurgeryDepartment Of Dental CareDepartment Of ENTDepartment Of RadiologyDepartment Of PhysiotherapyDepartment Of CardiologyPaediatricsDepartment Of NeurologyLaboratory ServicesX RayECG DEPARTMENT NAME Dr MK MehtaDr Rama YadavDr Avaneesh HasizaDr Amit GoelDr VivekDr. Keya BarmanDr Vikas APPOINTMENT DATE LEVEL OF EMERGENCY --- Select ---value="Call back from doctor within 15 - 30 min (For Super Urgent issues)"Call back from doctor within 30 - 60 min (For Urgent issues)Call back from doctor within 1 - 4 Hr (For important issues) PATIENT NAME PATIENT AGE GENDERMaleFemale MOBILE NUMBER ALTERNATIVE PHONE NO. E-MAIL ADDRESS ALTERNATIVE PHONE NO. DESCRIBE YOUR PROBLEM (OPTIONAL)
