| * | Arival Date |  |
| * | Departure Date |
| * | Type of Room | Select the Type of Room Cottage Single Occupancy Cottage Double Occupancy Deluxe Rooms(A/c & TV) Single Occupancy Deluxe Rooms(A/c & TV) Double Occupancy Special Rooms Single Occupancy Special Rooms Double Occupancy General Ward
| * | No. Of Patients |
| * | Accompanying People |
| * | Your Name |
| * | Contact No. |
| * | Email ID: |
|  |  | * mandatory fields .