Rehab for Autism & ADHD Under the direction of Dr. Kapil Dev | Appointment Booking📋 Patient Intake Form Full Name * Age * Sex * Select…MaleFemaleOther Mobile Number * Complain / Reason for Visit *🗓️ Select Required ServicesPrimary Services General Appointment (Consultation)₹500 Complete Assessment PackageSpeech Therapy Assessment (₹1000)Occupational Therapy Assessment (₹1000)Psychological Ass. (₹1000)Total: ₹3000 Individual Assessments Speech Therapy Assessment₹1000 Occupational Therapy Assessment₹1000 Psychological Assessment₹1000 Select Assessment Time Slot * 5:00 PM – 6:30 PM 6:30 PM – 8:00 PM Payment Required₹0 Scan QR or pay to UPI ID: 9304140878@okbizaxis Transaction Number * Payment & CancellationPayment is non-refundable once the appointment is confirmed.Cancellations must be requested at least 24–48 hours before the scheduled slot.In case of no-show, the amount will be forfeited.Rescheduling allowed once, subject to slot availability.Appointment & AssessmentBooking is confirmed only after transaction verification by the clinic team.Please arrive 10–15 minutes before your scheduled time.Bring previous medical records, reports, or prescriptions if any.Assessment slots (5–6:30 PM / 6:30–8 PM) are fixed — late arrivals may result in a shortened session.Patient & GuardianA parent or legal guardian must accompany patients below 18 years.Information provided must be accurate — false details may lead to cancellation without refund.The clinic reserves the right to reschedule in case of an emergency or doctor unavailability.Privacy & DataPatient information is kept strictly confidential and used only for treatment purposes.Details will not be shared with any third party without consent.Medical DisclaimerThis booking is for assessment/consultation only — not a guarantee of diagnosis or treatment outcome.Dr. Kapil Dev and the clinic team reserve the right to recommend alternative services based on assessment findings. I have read and agree to the Terms & Conditions *Please Select a Service