Patient Visit Status Department*IPDOPDHOME VISITHospital / Business / Clinics*Aries PhysioCareTrinity HospitalPhoenix HospitalMax Super Speciality ClinicAlexis ClinicNumber Of Visit*Please enter a number from 1 to 1000.Kindly Enter The Number Of Visit In Numeric.City*MumbaiNavi MumbaiThanePuneNagpurSuratAhemdabadGoaSelect Your CityVisit Date* DD slash MM slash YYYY Visit Time* : Hours Minutes AMPM AM/PMPatient Name* First Last Therapist Name* Dr First Name Last Name Therapist Email ID* You will Receive a Copy Of Submitted DetailsPayment Method*CashGpay / Paytm / NeftChequeAdvanced PaidPay LaterCash Received (Mention the Amount)*Kindly Deposit To Bank Or Transfer Via UPI Account Name : Aries PhysioCare Account No : 918020083777976 GPay / Paytm No : 9136447006Screen Shot Of Payment*Max. file size: 6 GB.In Case Of Advanced Paid Kindly Mention Paid In Advanced Via Gpay Or Any UPI. For Later Payment Ask The Patient Payment Method And Mention The Date Of Payment. GPay / Paytm : 9136447006 NEFT : Account No - 918020083777976 ; IFSC - UTIB0003388Cheque NO*Kindly Deposit To The Axis Bank Account. Cheque should Be On The Name Of " Aries PhysioCare" Deposit Account No : 918020083777976Payment Date* DD slash MM slash YYYY If its Advanced Paid Kindly mentioned The Date of the Payment Made. And If its Pay Later Kindly mention the Date when the patient is planning to pay.Treatment Protocol*Session Report*Progress Report*Queries Related To The Protocol / Treatment
