Demo activity Quantity remaining: 1,000


You are currently purchasing:

XXX clinic

UGX 1,000

Payment Reference: CPG5H

Description:

testing testing ...
  1. Enter one or more recipient emails or mobile phone numbers.
  2. Select and fill out any schedules or request where applicable.
  3. Select your preferred payment method.
  4. Correctly enter the four-letter captcha.
  5. Then click the 'Continue' button.
Select a schedule of your choice
Recipient(s) * Enter mobile number or email to receive the ticket/receipt.
Requests
Card Number (Required)
Card Name (Required)
Patient Name (Required)
Gender (Required) [Gender of patient]
Age (Optional)
Date time (Required)
Patient remarks (Optional)
Doctor remarks (Required)
Any tests (Optional)
Treatment (Required)
Admitted days (Required)
Cost (Optional)

Current total:


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