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Install AKIVA App
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Install AKIVA App
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Doctors / Surgery Booking :
Call +91-7880001778
Patient Helpline :
Call +91-8818814030
Refer a Patient
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Doctor Referral Doctor
Referring Doctor Mobile Number
*
Enter 10-digit Indian mobile number (without +91)
Referring Doctor Name
*
Referring Doctor Email
*
Doctor City
*
— Select CITY —
Agar Malwa
Alirajpur
Anuppur
Ashoknagar
Balaghat
Barwani
Betul
Bhind
Bhopal
Burhanpur
Chhatarpur
Chhindwara
Damoh
Datia
Dewas
Dhar
Dindori
Guna
Gwalior
Harda
Hoshangabad (Narmadapuram)
Indore
Jabalpur
Jhabua
Katni
Khandwa
Khargone
Maihar
Mandla
Mandsaur
Mauganj
Morena
Narsinghpur
Neemuch
Niwari
Pandhurna
Panna
Raisen
Rajgarh
Ratlam
Rewa
Sagar
Satna
Sehore
Seoni
Shahdol
Shajapur
Sheopur
Shivpuri
Sidhi
Singrauli
Tikamgarh
Ujjain
Umaria
Vidisha
please enter City of Clinic / Work / Practice
Patient Name
*
First
Last
Please Enter Patient Name
Patient Mobile Number
*
Enter 10-digit Indian mobile number (without +91)
Patient's Age
PATIENT City
— Select CITY —
Agar Malwa
Alirajpur
Anuppur
Ashoknagar
Balaghat
Barwani
Betul
Bhind
Bhopal
Burhanpur
Chhatarpur
Chhindwara
Damoh
Datia
Dewas
Dhar
Dindori
Guna
Gwalior
Harda
Hoshangabad (Narmadapuram)
Indore
Jabalpur
Jhabua
Katni
Khandwa
Khargone
Maihar
Mandla
Mandsaur
Mauganj
Morena
Narsinghpur
Neemuch
Niwari
Pandhurna
Panna
Raisen
Rajgarh
Ratlam
Rewa
Sagar
Satna
Sehore
Seoni
Shahdol
Shajapur
Sheopur
Shivpuri
Sidhi
Singrauli
Tikamgarh
Ujjain
Umaria
Vidisha
OTHER
OUTISDE INDIA
कृपया भारत में उस शहर (जिले) का नाम दर्ज करें जहां रोगी वर्तमान में स्थित है ; (a) यदि रोगी भारत से बाहर है तो – ‘Outside India’ चुनें; (b) यदि शहर सूची में नहीं है तो – ‘Other’ चुनें
Purpose of Referral
*
— Select Choice —
OPD
Surgery
Remarks / Details / Comment / Message
Submit