Patient Registration - Laxsara Care

Laxsara Care

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Patient Registration

Personal Information

First Name

Last Name

Email Address

Mobile Number

Enter your 10-digit Indian mobile number (e.g., 9876543210)

Date of Birth

Gender

Address Information

Address Line 1

Address Line 2

City

State

Postal Code

Country

Account Security

Password

Enter a 4-digit numeric password (e.g., 1234)

Confirm Password

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