Rehab for Autism & ADHD Under the direction of Dr. Kapil Dev | Appointment Booking 📋 Patient Intake Form Full Name * Age * Sex * Select… Male Female Other Mobile Number * Complain / Reason for Visit * 🗓️ Select Required Services Primary Services General Appointment (Consultation) ₹500 Complete Assessment Package Speech 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 & Cancellation Payment 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 & Assessment Booking 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 & Guardian A 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 & Data Patient information is kept strictly confidential and used only for treatment purposes. Details will not be shared with any third party without consent. Medical Disclaimer This 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