JMHeal - Subscription Renewal Form - For Medical Professionals


Dr.
Name of Clinic
Clinic Address
 ,
,
Contact Information
Clinic (Ph) Cell No Email ID:

Period for Subscription Renewal
Requested subscription will be valid for the subscribed period from the next day of current subscription expiry date.

I would like to renew my subscription for next

Enclosed Payment Details

Amount (INR)*# Cheque/DD*# Issuing Bank
Branch Details Issue Date Courier Details

By submitting this form, I accept the Terms and Conditions for JMHeal Subscription shown here

* Please note the your JMHeal subscription renewal is subject to realization of funds from your sent Cheque/DD. Your subscription will be renewed/extended for the request period, once we receive the funds in our bank account after presenting the Cheque/DD for clearing. Add Rs.100/- only for outstation (any other Indian city except Bangalore) Cheque.while sending the payment to us

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