Special Corporate Package
Naturaopathy & Wellness Hospital in Coimbatore
Enquire Now

Guest Registration Form

Emergency number shouldn't match with personal number

Primary Health Objective *


Select a maximum of 2 objectives

Medical History

Physical Mobility

If there is any surgery older than 1 year, and is likely to have any impact on your programme, then kindly mark this as YES
Please share your health information accurately. You can mention NA if this is not applicable to you.

Upload Medical Data

Blood work shouldn't be older than 3 months from the date of application.

To evaluate your health form, we recommend you to kindly upload the following documents:

CBC | Blood glucose | Lipid | Kidney & Liver function test | Vit D-3 & B-12 | Thyroid profile | ECG- if age > 60 yrs | 2D Echo - if there is a cardiac history or age > 45 yrs | X-Ray/MRI if applicable | Urine & Stool report OR any other test that you routinely monitor.

Kindly upload Medical Reports (upto 5 files)
Recommended: CBC | Blood glucose | Lipid | Kidney & Liver function test | Vit D-3 & B-12 | Thyroid profile | ECG- if age > 60 yrs | 2D Echo - if there is a cardiac history or age > 45 yrs | X-Ray/MRI if applicable | Urine & Stool report
Upload additional files (upto 5 files)

Terms and Conditions *

I affirm that the information above provides a complete and accurate record of my current health and lifestyle. This includes all known medical conditions and any other information that may be relevant to my engaging in any of the treatments or services at The Healing Hills. I have been explained to in detail, and have completely understood the treatments. I am aware that all treatments and activities are undertaken at my own risk. I hereby absolutely and irrevocably release (The Healing Hills), its employees, representatives, agents or assignees from any claim, legal or otherwise, from accidents, injuries or outcomes that may occur as a result of my participation in any such activities, programmes or treatments.

Menu