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Patient Information

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Phone No

Appointment Information

Consult for

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Medical History/Issues/Problems

Associated Disease

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Payment Details

Cash on Visit

Please complete your bKash payment at first, then fill up the form below.
bKash Personal Number : +88 01722-883-923

bKash Sender Number

Transaction No

Amount

bKash Payment Instructions

Dial *247# from your phone or use bkash app
Select Send Money option
Enter receiver bkash account number as 01722-883-923
Enter amount as 1,000/- Tk
Use reference as DIJ
Enter your bkash PIN number to confirm it

You will receive a SMS from bkash about your payment confirmation and there will be a Transaction ID.
After you fill up the above booking form & pay the consultancy fees we will make a contact with you to confirm the appointment at your convenient time. If you require any assistance during fill up this Online Doctor Consultation form please call us. We are very happy to assist you.

Our Helpline: +88 01737-091-619

Please complete your Nagad payment at first, then fill up the form below.
Nagad Personal Number : +88 01723-810-292

Nagad Sender Number

Transaction No

Amount

Nagad Payment Instructions

Open Nagad mobile menu on Nagad app
Select Send Money option
Enter receiver Nagad account number as 01723-810-292
Enter amount as 1,000/- Tk
Use reference as DIJ
Enter your Nagad PIN number to confirm it

You will receive a SMS from Nagad about your payment confirmation and there will be a Transaction ID.
After you fill up the above booking form & pay the consultancy fees we will make a contact with you to confirm the appointment at your convenient time. If you require any assistance during fill up this Online Doctor Consultation form please call us. We are very happy to assist you.

Our Helpline: +88 01737-091-619

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