Custom Payment Using Your Paytm Wallet

Complete the form below and enter an amount you have to pay and click on 'Submit' to proceed to the next step to complete the payment using your Paytm wallet. For assistance please call 033-4406-8000 or Email to telemedicine@drpbanerji.com

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Name of the Patient:*
Representative of the Patient:*
Location: *
Telephone No: *
Email ID: *
Service You Are Availing:*
Payment Amount (Rs.): *

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