By accepting EYE-TREATMENT on phone, you understand and agree with the following:-

1. You understand that you may expect the anticipated benefits from the use of telemedicine in your eye-care, but that no results can be guaranteed or assured;
2. You understand that the laws that protect the privacy and security of health information apply to telemedicine and you understand that no doctors from Team DIVYADRASHTI would be responsible for any untoward reactions of treatment advised;
3.  You understand that you are fully responsible for payment; and
4. You understand your Doctor, in his or her sole discretion and professional judgment, may determine that telemedicine services are not appropriate for some or all of your treatment needs and, accordingly, may elect not to provide telemedicine services to you & you may have to visit at eye clinic at the earliest for best & appropriate treatment. I Agree to all the above. Patients Name: ____________, Age_, Telephone No_______
5. DIVYADRASHTI Payment details:-
   1) PayTm or Google pay on 9820013035 Or
   2) NEFT /RTGS on:
   DIVYADRASHTI EYE CARE CENTRE
   Current Account
   Address: Chamunda circle, SVP Road, Borivli-West, Mumbai-92.
   Account No: 50200004058432
   IFSC Code: HDFC0000145
   Pl share the screen shot once payment done