Take the first step towards a personalised consultation

Please complete the following form to request an appointment. Submission of this form does not guarantee an appointment. Your appointment will be confirmed separately by the clinic.

Who is the consultation for?

Full name

Age

Gender

How can we reach you?

Mobile number

Include the country code if outside India, e.g. +1, +44, +971.

Email address

City and state / country

Consultation preferences

Preferred consultation type

In-clinic (Shahibaug, Ahmedabad)Online (video or audio)

Preferred doctor

Dr. Chirag Shah, D.H.M.SDr. Nehal Shah, B.H.M.SNo preference

Preferred date

Preferred time (IST)

Clinic hours are 9:00 AM – 1:00 PM IST.

Reason for consultation

A brief description of the health concern, how long it has been present, and anything already tried.

Medical reports

Do you have relevant medical reports?

YesNo

Patient declaration

By submitting this appointment request, I confirm that the information provided by me is accurate to the best of my knowledge. I understand that:

Submission of this form does not guarantee an appointment.
My appointment will be confirmed separately by the clinic.
Online consultation may not be appropriate for every health concern.
The doctor may recommend an in-person consultation or another appropriate healthcare service when necessary.
In case of a medical emergency, I should seek immediate emergency medical assistance.

I agree to the Privacy Policy and consent to the processing of my information for appointment and consultation purposes.

The clinic confirms by email or WhatsApp, usually within one working day.