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If filling the form for ‘other’  then please specify your relationship- 
Patient name? *
patient age? *
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Please select a slot *
I only work in the given time slots. Do confirm via mail or call before appointing a slot.

Monday to Friday - 7pm to 9pm
Per session is 40 mins
Time
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Please select a day *
From Monday to Friday. EXCEPT public holidays.
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Is this your first session? (With me) *
If Yes then list the session no. (Eg- 1st, 2nd...)
What is your email address? *
Phone number *
Charges- Rs 1500/- per session (40 to 45 mins). 

Choose payment option - 
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