Kindly fill up this form
  1. [intl_tel* phone1]
  2. [intl_tel phone2]
  3. 1. Rs. 50 per petient
    2. Security Deposit - Rs. 3,500 (one time non-refundable)
    Slot wise
    1. Slot = 2hrs, 1 day a week
    2. Rs. 1,000 monthly
    3. Security Deposit - Rs. 3,500 (one time refundable)

* Required