GSBS Medical Trust offers online (video) consultations for the following Specialties: Psychiatrist, Psychologist, Counselor, Dietician.
Please fill out the form below to request an appointment. Our staff will get in touch with you for your preferred date & time of appointment.
For any queries, please call +91-7715026134 or email us on info@gsbs@medicaltrust.org.
Your name
Age
Gender
MaleFemaleOther
Mobile No.
Email
Address / Location
Specialty (Tick all specialties that you wish to book appointments for)
PsychiatristPsychologistCounselorDietitian
Consulting Doctor Name/s (in case of preferences)
Nature of Tele-Consultation
I understand that teleconsultation involves consultation with a registered healthcare professional using audio, video, or digital communication, without a physical face-to-face examination.
Limitations of Tele-Consultation
I understand that: • Teleconsultation has certain limitations compared to physical consultation. • Diagnosis and treatment are based on the information I provide. • The doctor may advise physical examination, investigations, or hospital visit if required.
Consent for Tele-Consultation
I hereby voluntarily consent to receive healthcare services through teleconsultation from GSBS Medical Trust / HealthRakshak and the consulting doctor.
Privacy & Confidentiality
I understand that: • My personal and medical information will be kept confidential. • Reasonable security measures will be taken to protect my data. • Absolute confidentiality cannot be guaranteed due to risks associated with electronic communication.
Emergency Situations
I understand that teleconsultation is not meant for medical emergencies. In case of emergency, I will visit the nearest hospital immediately.
Follow-up & Records
I consent that my consultation details may be documented and securely stored by GSBS Medical Trust for medical and legal purposes.
Declaration
I confirm that the information provided by me is true and complete to the best of my knowledge. I have read and understood all the above points and agree to proceed with teleconsultation.
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