New Patient Registration Form
For first-time patients. Helps us create your medical and contact record.
- Personal details
- Emergency contact
- Medical history summary
Forms to Make Your Visit Smooth
Download, print, and complete the relevant forms at home. Bringing them to your appointment saves time, reduces waiting, and helps us focus on your care from the moment you arrive.
PDF Format
Print-Friendly
Downloadable Patient Forms
Select the form you need, download it, and bring the completed copy to your appointment.
Medical History & Consent Form
Records your health conditions, medications, allergies, and treatment consent.
- Past illnesses
- Current medications
- Informed consent signature
COVID / Health Declaration
Self-declaration of recent symptoms, travel, or exposure for clinic safety.
- Symptom checklist
- Travel / exposure history
- Date and signature
CGHS Empanelment Form
Required information for Central Government Health Scheme beneficiaries.
- CGHS card details
- Beneficiary information
- Treatment authorisation details
ECHS Empanelment Form
For Ex-Servicemen Contributory Health Scheme beneficiaries and dependents.
- ECHS card details
- Dependent information
- Service / pension details
ESI Form
For Employees State Insurance beneficiaries receiving treatment at our centre.
- ESI / e-Pehchan card
- Employer and IP details
- Declaration signature
UP Police Form
For serving and retired Uttar Pradesh Police personnel and dependents.
- Official ID details
- Dependent information
- Scheme authorisation
Feedback Form
Help us improve by sharing your experience, suggestions, or appreciation.
- Visit rating
- Service feedback
- Suggestions
How to Fill the Forms
A few simple tips to help you complete the paperwork accurately and quickly.
Be Accurate
Use your full legal name, correct contact details, and up-to-date medical information. Accuracy helps us provide safer care.
Sign Where Needed
Unsigned consent or declaration forms may delay your appointment. Please sign and date all required fields.
Bring Photo ID
Carry a government-issued photo ID and your scheme card (CGHS / ECHS / ESI / UP Police) if applicable.
Online Pre-Registration
Prefer to register online? Fill in the details below and optionally upload your existing reports. We will prepare your file before you arrive.
Forms & Registration FAQs
Common questions about forms, pre-registration, and your first visit.
Do I need to fill all forms before my first visit?
We recommend completing the New Patient Registration Form, Medical History & Consent Form, and any scheme-specific form (CGHS/ECHS/ESI/UP Police) before your visit. You can also fill these at the clinic if needed.
Can I submit forms without printing them?
Yes, you can use the online pre-registration form on this page. For signed consent forms, you may bring the printed form or complete it at the clinic under staff guidance.
What documents should I bring with the forms?
Please bring a government-issued photo ID, your scheme card if applicable, any previous dental records or prescriptions, and your completed forms.
Are my uploaded reports kept confidential?
Yes. Any reports uploaded through our pre-registration form are used solely for treatment planning and are handled in accordance with our privacy policy and clinical confidentiality standards.
Visiting Us for the First Time?
Learn what to expect during your first appointment, how to prepare, and how our team will guide you through every step.