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Admission request form

Sex :
Marital Status
Request Check in Date
Check out Date
Request Package  View Membership Pakage Rate and other Information
Request Days
Co Patient Please fill separate form for each Co-patient.
Attendant Details of Guest, Attendant, Child (who is not seeking treatment).
I have read and fully understood the rules of the Naturopathy & Yoga centre hereby mentioned and the details of charges and other details mentioned in the brochure and willingly accept the same.