Welcome to Disha Eye Hospital

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Request an appointment online: Disha Eye Hospital Barrackpore & Sheoraphuly


	Fields marked * are mandatory
Patient :	New Old/Follow up
PID No: ( Leave blank if new patient )
* Patient One :
Patient Two :
* Age :
Sex :	Male Female
Address :
Landline Number :
Mobile Number :
E-mail :
Kindly ensure your details ( Name, Contact No, E-mail ) have been entered correctly.

Preferences
To have your appointment confirmed, kindly fill this form atleast 24 Hours prior to your preferred date (depending on availability). APPOINTMENT BOOKING SLOTS ARE OPEN FOR THE NEXT 45 DAYS. DISHA IS CLOSED ON SUNDAYS
* Date :
Time :
*Select a location :
Select a doctor :
Briefly Narrate problem of the patient :

Do you want to send scanned copies of prescriptions/medical notes/previous case history for reference Along with this form?
Please use this option to send in JPEG/PDF format.

Disha Appointment Section will respond to you at the earliest.

Online Appointment Flow Chart

Points to Remember

Please inform whether you were a old patient of Disha Eye Hospitals or a new patient visiting for the first time.

If yes, and have visited earlier for consultation / surgery, please state your PID number.

Please state the present problem the patient is facing. This would help us to fix the appointment with the concerned specialist.

Please give your choice of date and doctor.

Please note down the name of doctor/date and time, if you have fixed the appointment over phone

Please do not fix multiple appointments to avoid inconvenience. Another patient might miss an opportunity.

Please report at the appointment time given.

Please note only one attendant will be allowed inside along with the patient.

Appointment request depends on availability of doctors, holidays, etc.