Appointment request

Request a suitable consultation time

This form sends a request to the clinic. It does not create or confirm an appointment until the clinic contacts you.

Before you submit

A simple, privacy-conscious request

Share only the minimum information needed for scheduling. A report upload is optional and stored privately for authorised clinic review.

Call+91 99679 66493

WhatsAppAsk about available consultation slots

LocationBansal Hospital, Bhopal

Patient portalTrack requests and securely view clinic updates.

Emergency: Do not wait for an online response. Contact local emergency services or the hospital emergency department.

Secure request

Appointment details

Fields marked * are required.

Full name *

Age *

Phone *

Email (recommended)Use this email to access your secure patient portal and receive updates.

Reason for appointment *

Preferred date

Preferred time

Consultation preference *Video requests are confirmed only after clinic review.

Patient type *

Preferred contact *

Pregnancy week (optional)

Optional reportPDF, JPG, PNG or WebP; maximum 8 MB.

Short scheduling note (optional)Maximum 500 characters.

After submission: Keep your reference number. The clinic will contact you using your selected method. Do not upload unnecessary identity documents or unrelated records.