What is the primary reason for seeking medical advice? * - Please select - General Health Concern Need Surgery Symptoms of Specific Illness Follow-up Other (please specify)
If Others, please provide details *
Are you allergic to any medication? * - Please select - Yes No
If yes, please provide details *
When did you first notice the symptoms? * - Please select - Less than 1 week ago 1-2 weeks ago 2-4 weeks ago More than 1 month ago Not sure
Have you consulted any healthcare professionals regarding your symptoms? * - Please select - Yes No
Based on your previous consultations, have you been advised to consider surgical treatment? * - Please select - Yes No Not sure
If other, please specify *
Have you undergone any diagnostic tests or imaging studies related to your condition? * - Please select - Yes No
If other, please specify *
Please describe patient's problem and symptoms *
Are you looking for yourself or someone else? * - Please select - Myself For Family Others
Does the patient have a valid passport? - Please select - Yes No
Do you have a valid passport? - Please select - Yes No
How soon do you need to visit India? * - Please select - Within few days Within a month Not time-sensitive
Do you have any preferences or requirements for the hospital or healthcare facility where you would like to undergo treatment? * - Please select - Yes No
What is more important to you? - Please select - Quality Affordability
