Dr. Vipin Kumar Jain

I, the undersigned, declare that the above information provided by me are true to the best of my knowledge and hereby provide my consent to the Manipal Hospital to provide Medical Care, Treatment, Conduct Investigations and Diagnostic Procedures necessary for the above mentioned individual by Medical Staff at Manipal Hospital. I, also understand that Manipal Hospital will not be responsible for any loss, damage or theft of any Personal Property/Belongings of Me/Patient/Visitors within the Hospital Premises. Including Patients rooms and Parking area. I agree to follow all the rules and regulations of Hospital and clear all the expenses incurred for My/Patient treatment on time as per the Terms and Conditions of Manipal Hospital,

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I would like to receive Hospital Info Alerts reports by Email
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I hereby give my consent and authorize Manipal Hospitals to process, store,use,disclose my personal or sensitive information/data collected as per Manipal Privacy Policy

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Patient Details

Payment Details

UHID
Patient Name
Doctor Name
Date & time
Mode of Consultation
Location
Mobile Number
Email ID
Consultation Charges	Rs. NA/-

I hereby agree to the REFUND POLICY and TELECONSULTATION POLICY

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Payment Details

Pre Registration ID
Patient Name
Doctor Name
Appointment Date & time
Mode of Consultation
Location
Mobile Number
Email ID
Registration Charges
Consultation Charges
Total Amount Payable

I hereby agree to the REFUND POLICY and TELECONSULTATION POLICY

manipal-hospital-admin

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₹ 500-500-

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Fellowship & Membership

The Association of Physicians of India

Indian Rheumatology Association

Hospital Infection Society of India

Aids Society of India

Indian Society of Cardiology

Field of Expertise

All complicated patients requiring intensive care

Languages Spoken

Hindi

English

Marwari

Arabic

Languages Spoken

Hindi

English

Marwari

Arabic

Fellowship & Membership

The Association of Physicians of India

Indian Rheumatology Association

Hospital Infection Society of India

Aids Society of India

Indian Society of Cardiology

Field of Expertise

All complicated patients requiring intensive care

Field of Expertise

All complicated patients requiring intensive care

Fellowship & Membership

The Association of Physicians of India

Indian Rheumatology Association

Hospital Infection Society of India

Aids Society of India

Indian Society of Cardiology

Languages Spoken

Hindi

English

Marwari

Arabic

Centre of Excellence

Other Specialities

Manipal Hospitals