Demo Activity
Quantity remaining: 1,000
You are currently purchasing:
XXX clinic
UGX 1,000
Payment Reference:
CPG5H
Description:
testing testing ...
Enter one or more recipient emails or mobile phone numbers.
Select and fill out any schedules or request where applicable.
Select your preferred payment method.
Correctly enter the four-letter captcha.
Then click the 'Continue' button.
Choose schedule
*
2019 - Start Time - 2019-01-04 16:01:00 End Time - 2019-12-31 16:01:00
Select a schedule of your choice
Recipient(s) *
Enter mobile number or email to receive the ticket/receipt.
Requests
Card Number
(Required)
--- Card Number ---
001
002
003
004
Card Name
(Required)
Patient Name
(Required)
Gender
(Required)
--- Gender ---
male
female
[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:
Choose Payment Method
MTN Mobile Money
Airtel
Visa/Master Card/American Express
MTN mobile number
Buying MTN mobile number
Airtel mobile number
Buying Airtel mobile number
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*
It is not case sensitive
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)
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