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CareAyu Mind Consultation Form

Online Consultation Form

Step 1 of 2

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  • Before Proceeding with Scheduling and Booking Consultation, Please fill the following form. It helps us for providing an efficient telemedicine experience.
  • First Time or Followup
  • Reports

  • Drop files here or
    Accepted file types: jpg, jpeg, png, pdf.
      Upload Medical Reports or Past Prescriptions
    • Drop files here or
      Accepted file types: jpg, jpeg, pdf, png.
        Any of the Valid ID Proof
      • Patient ID

      • Enter Your Patient ID (Please check the last time mail or prescription)
      • I already filled this form

      • Profile Details

      • Date Format: DD slash MM slash YYYY
      • Health Complaint

      • Tell us about your health problem
      Save and Continue Later
      • Please enter a number from 10 to 200.
      • Please enter a number from 10 to 220.
      • Any Drug or Food Allergy?
      • Currently under any antidepressants/sleep medication? If yes, please specify
      • I hereby agree that the above submitted informations are correct to the best of my knowledge and I understand the importance of the data provided here for the analysis and diagnosis of the condition. I completely own the responsibilities of recieving the telemedicine advises by providing the wrong information.

        Issual of prescription is not guaranteed with the consultation at CareAyu. The Doctor holds the "Right" to prescribe the medicine or not. There will not be any refunds due to these decisions.


        I understand that telemedicine is the use of electronic information and communication technologies by a health care provider to deliver services to an individual when he/she is located at a different site than the provider; and hereby consent to Careayu providing healthcare services to me via Telephone, Email or Chat.
      Save and Continue Later
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