Online Consultation

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

Name

Email Address

Phone

Age

SexSelectMaleFemaleOther

New patient or Old patient *New patientOld patient

Please type the reason for seeking the consultation *

Last Consultation Date

Review Date

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

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

Drag and Drop (or) Choose Files

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

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