Patient Registration | P.D. Hinduja Hospital Khar
Appointment
OPD Diet Consultation Appointment Booking

022-61746780
Mon-Sat from 11am - 2pm

022 - 6174 6780
Mon-Sat from 11am - 2pm

Emergency
Emergency

022-61746099

022-61746099

022-61746098

022-61746098

Staying in touch makes
it easier to be there for you.

Reach Us
Home > Reach Us > Online Registration

Online Registration

  • First Name *

  • Middle Name

  • Last Name *

  • Date of Birth *

  • Age *

Gender *

Marital Status *

  • Telephone Number (Resi.)

  • Telephone Number (Office)

  • Email ID *

  • Residential Address *

  • Fax Number

  • Mobile Number *

  • Pin / Zip Code *

  • Nationality *

  • Occupation *

Responsible Person Details
  • First Name

  • Middle Name

  • Last Name

Relation

  • Mobile

  • Referring Doctors Name

  • Consulting Doctors Name

  • Type characters shown in the picture *

    Type characters shown in the picture