Online Consultation Booking - Rashmi Skin And Hair Clinic

Note

This platform is designed preferably for review of patients who have already been seen by Doctors in the clinic. New patients can also avail this facility.
It is not an interactive session , the Doctor will review your notes, photograph and get back to you as soon as possible (Usually with in 48 hours) via email/ Phone.
It is designed to help patients who cannot physically attend the clinic.
All the information, details and photograph uploaded are confidential.
If needed the doctor can request you to attend the clinic in person.

DISCLAIMER

Please note that you are choosing to have online consultation out of your own will.
Use this only when you cannot physically attend the clinic.
I hereby give consent to be evaluated by the treating doctor for myself or my relative by online /tele/ digital medium fully understanding the limitations of the technology.
The information given below is true to the best of my knowledge.

Tick to confirm that you have read, understood, accepted the Disclaimer, and ready to fill the details and upload the photos

Click the checkbox before sbumitting.

First Name *

Enter first name.

Last Name

Age *

Enter your age.

Sex *

Select gender.

Contact Number *

Enter your contact number.

Email *

Enter your email address.

New patient or old patient *

New patient

Old patient

Select patient type.

Please type the reason for seeking the consultation *

Enter your reason of visit.

Last Consultation Date

Review Date

Did you suffer from any side effects due to the medications, if any side effects please type them

Enter your reason of visit.

Please Click photos of affected part both from a distance and close up with clarity. Also upload results of Diagnostic tests/Investigations requested by Rashmi Skin And Hair Clinic ( Each file size must be less then 3.5 MB )*

Upload images.

Upload your prescription here. ( Each file size must be less then 3.5 MB )