This will be your username for login.
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"Please enter a valid email"
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"Please enter your name"
If you are less than 18 yrs, you can register but I will have to Contact your parents before consultation.
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Please enter your age
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"Please enter a valid mobile number"
Gender:
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Please choose at least one of the options
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"Please enter a valid pincode"
Choose an identity proof:
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Identity proof is mandatory as per telemedicine regulations.
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Identity proof is mandatory as per telemedicine regulations.
This will be your login password choose a strong one.

I declare that I have entered the right information and I consent for a tele- or in-person consultation.

By submitting the form you attest to the above statement.