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Base de données des hopitaux en Inde / Database of hospitals in India

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Prenoms du Patient / Given Names of the Patient

Nom du Patient /Surname of the Patient

Email

Votre pays de residence/Nationalite / Your country of residence/Nationality

What is your medical condition?

Avez-vous ete diagnostiser? Si oui veuillez charger le document (resultat) / Have you been diagnosed? If yes, please upload the document (result).

Le patient sera accompagne par combien de personnes? / How many people will accompany the patient?

Code

Phone

J'accepte les conditions générales /I accept the terms and conditions.

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