BASIC INFORMATION FORM Select clinic ONLINE CHILD CENTRIC Select MR MRS First Name Last Name Date of Birth Gender Male Female Other Location and Postal address Contact number Email id Skype id Complaints/diagnosis Reports and images Occupation Reference Language preferred Translator details Homeopathic Pharmacy/ Homoeopath details Family physician/ consultant details DAY OF APPOINTMENT PREFERRED WEDNESDAY FRIDAY CONSENT FORM - The Video recording becomes an essential part for the assessment on our behalf. Swasthya Homeopathic Healing puts the confidentiality and security of clients and partners at a high priority And we would like to have your consent for the same as below. I understand that my case interview maybe recorded on video for the purpose of future reference, study and teaching.And the video will be highly kept anonymous with masking and voice alteration. Hence I give my consent for the same. YES NO Any other Queries ? Send