Contact us

Arya Charitable Trust
215, Barbate Square, Near Garden, Lakadganj,
Nagpur 440008 (MS)
Phone: +91 712 646 4646 / 645 4567
Email: aryacharitabletrust@yahoo.com
Website: www.aryacharitabletrust.org

Appointment with...
Dr Anil B. Jalan or Dr. D. K. Chopade
Please fill in the following Query Form
(All entries required)

Name of the person seeking appointment:
Age:
Address:
Telephone number:
Mobile number:
Name of the patient:
: : Referring Doctor : :
Name:
Address:
Why do you want to meet the geneticist/specialist?
1. Problem of the patient/person/family:
2. Relation of the person asking for appointment with the affected person:
3. If diagnosis is done - What is the diagnosis?
4. When and where do you want to see the geneticist/specialist? (Nagpur/Nashik/Mumbai)