Online Opinion

MaleFemale

Note- Kindly mention your complaints, significant past history etc. in the above box.


Note - Please upload only PDF or Word Documents upto 5mb.

Informed Consent For Clinical Consultation

I wish to receive consultation services from TEJNAKSH HEALTHCARE LTD.

I understand that I will provide all clinical data which includes all clinical investigations reports for my treatment and I will not conceal anything about my past diagnosis & treatment done.

I understand that these consultations do not constitute clinical supervision and that I remain completely responsible – ethically and legally – for the decisions I make in my own clinical case situations. My consultant will provide me with an opportunity to discuss clinical cases and issues about which he may have expertise, and he may help me consider treatment options for patient.

I understand that all relevant clinical information to my treatment will be kept confidential. No clinical case records and photographs of patients will be published in Visual or Print media without prior consent of the patient.

I agree to pay consultation fees online.


Consent to
Yes
Digital Signature
Enquiry email : enquiry.tejnaksh@gmail.com
Enquiry contact : 9422285213

Note - Online Opinion fees is Rs.900, You will be redirected to PayUMoney for payment.