Patient Intake

Share your eye complaint before your visit

Choose your visit type, fill the required details, then type or record your complaint.

Clinic intake: Patient details are submitted to clinic staff for history-taking support before consultation.

New Patient Details

Referred by Prefix First name * Last name * Date of birth Age Email ID Mobile number * WhatsApp number Father's / Mother's / Husband's name Address Pin code

Complaint / History

Type your complaint or history

Record your complaint

Tap record, speak clearly, then stop when finished.

No voice recording added.

English transcription of voice messages will be generated in the secure clinic version.

Previous eye treatment / surgery?

Helpful points to mention

Which eye: right, left, or both?
Since when did the problem start?
Is it improving, worsening, or the same?
Any pain, redness, watering, discharge, flashes, floaters, injury, or vision loss?
Current medicines or allergies?

Share your eye complaint before your visit

New Patient Details

Repeat Visit Details

Complaint / History

Record your complaint

Helpful points to mention

Patient submissions

Information sent to clinic