Clinical Pre-Intake

Diagnostic Appointment & Intake

Please complete this clinical pre-appointment form. Once received, our operations desk will confirm your appointment time and phlebotomist assignment via Email and WhatsApp.

1 Patient Info

2 Test Selection

3 Mode & Slot

4 Clinical History

5 Confirm

Step 1: Patient Profile & Contact

Enter the details of the individual undergoing the diagnostic tests.

Patient Full Name *

Age (in years) *

Gender *

WhatsApp Mobile Number * Appointment confirmation will be sent here.

Email Address * Verified test report will be delivered here.

Step 2: Test Selection & Packages

Choose a health package or individual laboratory investigations.

Primary Health Package *

Common Individual Tests (Select applicable)

Complete Blood Count (CBC) Fasting Sugar & HbA1c Lipid Profile (Cholesterol) Liver Function (LFT) Kidney Function (KFT) Thyroid Profile (T3/T4/TSH) Vitamin D & Vitamin B12 Complete Urine Routine

Step 3: Sample Collection Mode & Slot

Choose whether you prefer home collection or visiting our center.

Collection Preference *

🏠 Home Sample Collection A certified phlebotomist visits your address with sterile cold-chain sample kits.

🏥 Center Visit (Yelahanka) Visit Bhavish Arcade, Attur Main Road, Santhosh Nagar, Yelahanka.

Residential Address in Bengaluru *

Preferred Date *

Preferred Time Slot *

Step 4: Clinical History & Fasting Status

Pre-test guidelines to ensure sample accuracy.

Will the patient maintain 10-12 hours fasting state? *

Yes (10-12 hr fasting) No (Non-fasting) Need guidance

Existing Conditions

Diabetes Hypertension / BP Thyroid Disorder Cardiac History

Step 5: Review & Confirm

Please review your appointment summary before final submission.

I agree to receive appointment alerts, test guidance, and diagnostic reports via WhatsApp and Email.