Enter the full file ID number. This is on the file given to you when you first visited our hospital.
Which number should we call on if we need any further information or want to talk to you?
Medical Information (તબીબી માહિતી)
Describe health related issue/s you are facing and concerns you have. Also mention symptoms etc...
Describe any other disease you have apart from diabetes and mention their duration as well.
Names of medicines, their dosage, and times of day. One medicine on one line. For example:
Drug Name XYZ 25mg - 1 - 0 - 1
Recent Reports (તાજેતરના રિપોર્ટ)
Please provide readings from recent pathology / other reports.
Mention dates of reports as well.
We recommend attaching a scanned copy of reports below as well.
Accepted file types: jpg, jpeg, png, pdf, doc, zip.
Attach scanned / digital copies of your recent reports here if you have.
Please provide last 7 days blood glucose readings.
Additional Information / Queries (વધારાની માહિતી / સંદેહ)
Payment Information (ચુકવણીની માહિતી)
Online consulting charges Rs. 800 for every new case and Rs. 400 for existing cases.
Fees once paid are valid for 5 days & non refundable.
Payment to be made via Paytm Wallet or online bank transfer - NEFT / IMPS.
Paytm Wallet Number: +91 9825138477
Bank Account Details
Bank Name: Bank of India
Branch: Kanpith, Lalgate, Surat
IFSC Code: BKID0002700
Account Name: Sonal Hospital & Diabetes Clinic
Account Number: 270020110000991
It will be best if you make payment for this consultation beforehand. This will speed up the process and help us revert quickly.
Please provide Paytm Wallet transaction id or reference number, your bank name, your account number, date and mode of transfer. This will help us find your payment easily.
Review & Submit (સમીક્ષા અને મોકલો)
Please review all information you have entered for accuracy, agree to the terms and send your request for e-consultation.
I understand and agree that e-Consultation is not comparable to clinical examination, and may be inferior - especially if symptomatic. However it has advantages of saving waiting and travelling time as well as expenses; and is particularly helpful in regular followups. I also assure that the above information is true to the best of my knowledge and belief.
This field is for validation purposes and should be left unchanged.