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Patient Registration

Faculty Patient Registration

First Name:

Last Name:

Date Of Birth

Bank Account

Designation

Nationality

Image

Email:

Phone Number

Password:

Confirm Password:

Gender

Male

Female

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Student Patient Registration

First Name:

Last Name:

Student Id

Date Of Birth

Degree

Department

Residential

Nationality

Bank Account

Email:

Phone Number

Password:

Confirm Password:

Gender

Male

Female

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Staff Patient Registration

First Name:

Last Name:

Date Of Birth

Staff Type

Nationality

Bank Account

Designation

Email:

Phone Number

Password:

Confirm Password:

Gender

Male

Female

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