Patient Registration
Access to your dashboard
Name
Email Address
Contact Number
Date of Birth
Your Address
Password
Confirm Password
Note :
Save your card details for the future transactions.
Card Number
Card Expire Month
Select Expire Card Month
1 - Jan.
2 - Feb.
3 - Mar.
4 - Apr.
5 - May
6 - Jun.
7 - Jul.
8 - Aug.
9 - Sep.
10 - Oct.
11 - Nov.
12 - Dec.
Card Expire Year
Select Expire Card Year
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
2043
2044
2045
2046
2047
2048
2049
2050
2051
2052
2053
2054
2055
2056
2057
2058
2059
2060
2061
2062
2063
2064
2065
2066
2067
2068
2069
2070
2071
2072
2073
2074
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