Patient Name (required)
Patient Age (required) Patient Sex (required) ---MaleFemale Patient Address (required) Patient Phone (required) Date of Sample Dropped
Email (required)
Which platform do you want your reports to be delivered? (required) ---EmailViberWhatsAppWeChat
Platform Detail (required)
Are you the patient? (required) ---YesNo
Patient Relation
Name
We will call the patient to re-confirm if this action is requested by them or not. If you have problem submitting please call 9861937345
The reports will be delivered between 10 am to 5 pm
Address: Sallaghari-1, Bhaktapur
Tel: 6612695, 6612705 ,9861937345
Email: info@iwamurahospital.com