Glocal

Virtual Clinic Powered by Hellolyf

Consult privately with doctors via online video from anywhere, anytime to get any kind of medical assistance

Registered Patients

First Name

Last Name

Age(Year)

Age(Month)

Gender

Pincode/Zipcode

E-mail

I accept the terms and conditions .

All fields are mandatory.

I understand that telemedicine is the use of electronic information and communication technologies by a health care provider to deliver services to an individual when he/she is located at a different site than the provider; and hereby consent to Glocal Healthcare Systems Pvt. Ltd. providing health care services to me via telemedicine.

I understand that the laws that protect privacy and the confidentiality of medical information also apply to telemedicine. I understand that I will be responsible for any co-payments or co-insurances that apply to my telemedicine visit.

I understand that I have the right to withhold or withdraw my consent to the use of telemedicine in the course of my care at any time, without affecting my right to future care or treatment. I may revoke my consent orally or in writing at any time by contacting Glocal Healthcare Systems Pvt. Ltd. at 3346000450. As long as this consent is in force (has not been revoked) Glocal Healthcare Systems Pvt. Ltd. may provide health care services to me via telemedicine without the need for me to sign another consent form.

I also agree to the Privacy Policy listed here

I can see and hear myself

Country Code | Mobile number

Your registered mobile no

On clicking submit, your password will be reset with a temporary system generated password which will be sent to your registered mobile no , the password can be changed using the password change option in your account.

Country Code | Mobile number

I accept the terms and conditions .

All fields are mandatory.

You have an appointment with on at .

Glocal

Virtual Clinic Powered by Hellolyf