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Congrats! You are now taking the first step towards better health by getting a second opinion from MyExpertDoc, India's most trusted medical second opinion platform!

STEP 1 (Patient information) → STEP 2 (Disease information) → STEP 3 (Payment)

PATIENT INFORMATION

Title:

First Name: *

Last Name: *

Age: *

Gender: *

Your Name (if you are not the patient):

Email Address: *

We will contact you using this email. Make sure it's accurate!

Phone Number: *

If you need phone consultation or our team has a question, we will call you on this number. Make sure it's accurate!

Your address: *

STEP 1 (Patient information)→ STEP 2 (Disease information) → STEP 3 (Payment)

DISEASE INFORMATION

WHAT IS THE REASON FOR CONSULT? *

DIABETES type 1 or 2

HIGH BLOOD PRESSURE (Hypertension)

BLOOD DISEASE (anemia, hemophilia, excessive bleeding, blood clots, or others)

CANCER (lung, breast, prostate, kidney, brain, bone, blood, or any other)

OTHER (please provide the details below)

IS THIS YOUR FIRST CONSULT? *

BRIEF DESCRIPTION OF CASE: *

Case details:

ADDITIONAL INFORMATION / REQUESTS:

Additional Information:

UPLOAD ALL FILES HERE (Doctor's notes, lab reports, scan images etc):

Each of the following buttons allows you to upload one file. If you have more than 5 files, please email them to us after submitting this form (you will get an email after you submit the form - just send attachments by replying to that email)

ALLOWED FILE TYPES: Only jpeg, jpg, doc, docx, and pdf are allowed.

FILE # 1:

FILE # 2:

FILE # 3:

FILE # 4:

FILE # 5:

If there is technical problem attaching a file, don't worry. Just email us, and we'll find a solution.

Do not click this button twice! Please wait for all files to finish uploading (this may take 1-2 minutes).

You will automatically be taken to the payment page.

STEP 1 (Patient information)→ STEP 2 (Disease information) → STEP 3 (Payment)

Payment
Thank you for choosing MyExpertDoc – India’s best medical second opinion platform. Please verify that the patient information on the left side is correct before proceeding with payment.

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Payment Total: ₹5,500

PATIENT INFORMATION

DISEASE INFORMATION

STEP 1 (Patient information)→ STEP 2 (Disease information) → STEP 3 (Payment)

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