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Name (First Name, Middle Name, Surname)*

Age*

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Date of Appointment*

Time of Appointment *
Morning 10am-10.30amMorning 10.30am-11.00amMorning 11.00am-11.30amMorning 11.30am-12.00amMorning 12.00pm-12.30pmMorning 12.30pm-01.00pmEvening 7pm-7.30pmEvening 7.30pm-8.00pmEvening 8.00pm-8.30pmEvening 8.30pm-9.00pmEvening 9.00pm-9.30pmEvening 9.30pm-10.00pm

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Pay the amount Rs.500/- by scanning below QR code via Gpay and mention Payment Receipt Details (Transaction No., Date, Bank details)*