FORM WIZARD

First Name

Last Name

Email Address

Phone Number

+99

Date of Birth

Select Gender :

Country

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Cardio Check $503

Ortho Consult $251

Gyn Exam $100

Pediatric Vaccines $50

Dental Checkup $80

X-ray Imaging $80

Blood Tests Varies

Eye Exam $90

Payment Details
Mode of Payment	:	Paypal

Source Information:

Google

Other

Payment Details :

Delivery Address

Payment Methods

C.O.D(Cash on delivery) UPI Credit/Debit Card

Card Number

Name On Card

Expiration Date

CVV

O.T.P Do not share O.T.P with anyone

Save this card

Saved Cards :

XXXX - XXXX - XXXX - 7646

XXXX - XXXX - XXXX - 9556

You will get the appointment details with appointment id SPK#1FR to Jogh12@gamil.com

Thank you for booking an appointment .

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