Patient Registration

Name of Patient

Email Address

Are you 18yrs or older? Are you 18yrs or older? Yes No

”Please

Are you inquiring about a pre-diagnosed health issue or a chronic illness? Are you inquiring about a pre-diagnosed health issue or a chronic illness? Yes No

If your condition is an acute emergency, please seek healthcare services closest to you. If your condition is an acute emergency, please seek healthcare services closest to you. I will seek emergency services somewhere esle

Is this booking for yourself, or on behalf of someone else? Is this booking for yourself, or on behalf of someone else? For myself For someone else

Organize, scan & prepare your medical records for shared screen viewing Organize, scan & prepare your medical records for shared screen viewing I understand

Your Doctor will be providing a second opinion/guidance on a current diagnosis Your Doctor will be providing a second opinion/guidance on a current diagnosis I understand

You will not receive any prescriptions in any form You will not receive any prescriptions in any form I understand

Are you a resident of the United States? Are you a resident of the United States?YesNo

Which state are you from?

Which city will you be joining from?

Select Specialty Select SpecialtyFamily MedicineWomen's HealthInternal MedicinePediatricsNephrologyPulmonologyDermatologyChronic PainFunctional MedicineGeriatricsOphthalmologyOrthopedicsSurgeryCritical Care

Select your Doctor Select your DoctorDr. SheelaDr. GauravDr. EstherDr. RavikumarDr. Charlene

Select your Doctor Select your DoctorDr. EstherDr. TingDr. FikayoDr. Naoko

Select your Doctor Select your DoctorDr. Fikayo

Dr. Esther will only accept patient bookings from residents of the state of Florida. International patients may make an appointment as well Dr. Esther will only accept patient bookings from residents of the state of Florida. International patients may make an appointment as wellI am a resident of FloridaI am not a resident of FloridaI am an international patient

Dr. Sheela will accept patient bookings from residents of the states of Ohio, Kentucky, Idaho, New York & North Carolina only. International patients are welcome to make a booking as well. Dr. Sheela will accept patient bookings from residents of the states of Ohio, Kentucky, Idaho, New York & North Carolina only. International patients are welcome to make a booking as well.I am a resident of Ohio, Kentucky, Idaho, New York or North CarolinaI am not a resident of those statesI am an international patient

Select your Doctor Select your DoctorDr. Charlene

Select your Doctor Select your DoctorDr. Khalid

Dr. Charlene is accepting patient bookings from residents of Florida only. International patients are welcome to make a booking as well. Dr. Charlene is accepting patient bookings from residents of Florida only. International patients are welcome to make a booking as well. I am a resident of FloridaI am not a resident of FloridaI am an international patient

Dr. Saad is accepting patient bookings from residents of Florida only. International patients are welcome to make a booking as well. Dr. Saad is accepting patient bookings from residents of Florida only. International patients are welcome to make a booking as well. I am a resident of FloridaI am not a resident of FloridaI am an international patient

Select your Doctor Select your DoctorDr. Saad

Select your Doctor Select your DoctorDr. Srikanth

Select your Doctor Select your DoctorDr. Juan

Select your Doctor Select your DoctorDr. Luis

Select your Doctor Select your DoctorDr. Naved

Select your Doctor Select your DoctorDr. Naved

Select your Doctor Select your DoctorDr. KariDr. KavitaDr. Linda

Dr. Kari is accepting patient bookings from residents of CA, TX, WA & OR. International patients are welcome to make a booking as well. Dr. Kari is accepting patient bookings from residents of CA, TX, WA & OR. International patients are welcome to make a booking as well.I am a resident of California/Texas/Washington or OregonI am not a resident of those statesI am an international patient

Dr. Linda is accepting patient bookings from residents of Alabama & Georgia. International patients are welcome to make a booking as well. Dr. Linda is accepting patient bookings from residents of Alabama & Georgia. International patients are welcome to make a booking as well.I am a resident of Alabama or GeorgiaI am not a resident of those statesI am an international patient

Select your Doctor Select your DoctorDr. Jay

Dr. Jay is accepting patient bookings from residents of Florida & Georgia only. International patients are welcome to make a booking as well. Dr. Jay is accepting patient bookings from residents of Florida & Georgia only. International patients are welcome to make a booking as well.I am resident of Florida/GeorgiaI am not a resident of those statesI am an international patient

Select your Doctor Select your DoctorDr. Nico

Dr. Nico is accepting patient bookings from the state of Indiana only. International patients are welcome to make a booking as well. Dr. Nico is accepting patient bookings from the state of Indiana only. International patients are welcome to make a booking as well.I am resident of IndianaI am not a resident of IndianaI am an international patient

We apologize. Due to state medical regulations, we are not permitted to process out-of-state patient bookings. We apologize. Due to state medical regulations, we are not permitted to process out-of-state patient bookings. Cancel registration & Return to Clinic page

Please select your Membership Plan Please select your Membership PlanOn-Demand (one time consult)Gold (Anytime for 6mo)Platinum (Anytime for 1yr)Contact Customer support

On Demand Plan US$300 (one time) On Demand Plan US$300 (one time) Confirm

GOLD Plan US$2500 (6 months) GOLD Plan US$2500 (6 months) Confirm

PLATINUM Plan US$5000 (12 months) PLATINUM Plan US$5000 (12 months) Confirm

Contact Customer Support Contact Customer Support Click here to book an appointment for Customer Support

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