Delhi/NCR:

MOHALI:

Dehradun:

BATHINDA:

BRAIN ATTACK:

011-4055 4055

77107-77107

0135-719 3333

0164-5212039

+91 9910204023

Max Healthcare Immigration Services

Select a centre near you

Select Center

Select the country of travel

Select a Country

Select a Country

Select age group and Package

Select Age Group / Category

Select Packages

Loading

Fill up your details

Please enter details as mentioned in your passport

Title is Required
Name is Required
Only Enter Valid Characters
Last Name is Required
Only Enter Valid Characters
Email is Required
Email should be a valid Email
Care of is Required
Name is Required
Only Enter Valid Characters
Phone is Required
Phone should be a digit
Phone should be a digit
Phone should be at least {{ $v.phoneNumber.$params.minLength.min }} digit
Phone should be at max {{ $v.phoneNumber.$params.maxLength.max }} digit
Phone should be a digit
Phone should be a digit
Phone should be at least {{ $v.alternatePhoneNumber.$params.minLength.min }} digit
Phone should be at max {{ $v.alternatePhoneNumber.$params.maxLength.max }} digit
Date of Birth is Required
Marital Status is Required
Gender is Required
Passport Number is Required
Passport Number should be atleast min {{ $v.passportNumber.$params.minLength.min }} char long
Passport Number should be at max {{ $v.passportNumber.$params.maxLength.max }} char long
Space and Special char not allowed
Passport Issue Date is Required
Passport issue date is earlier than DOB
Passport Expiry Date is Required
Passport Expiry date is earlier than Passport Issue date
Address is Required
City is Required
Only Enter Valid Characters
State is Required
Only Enter Valid Characters
Zip is Required
Zip should be a digit
Zip should be a digit
Zip should be at least {{ $v.zip.$params.minLength.min }} digit
Zip should be at max {{ $v.zip.$params.maxLength.max }} digit
Vaccination is Required
Please enter a valid date
Dose 2 date is earlier than Dose 1
Dose 3 date is earlier than Dose 2
Dose 4 date is earlier than Dose 3

Select appointment date and time

Date for Appointment*

Appointment Timeslot*

Loading

Thank You!

Your appointment is booked. Our agent will call you back shortly for the confirmation. For any assistance call 0172-5212000.

Preview your personal details before submitting

Print

Max Healthcare Immigration Form Preview

Date for Appointment:

{{appointmentDate}}

Appointment Timeslot:

{{appointmentTimeSlot}}

Selected Center:

{{center}}

Select Country:

{{country}}

Select Age Group:

{{age}}

Select Package:

{{package}}

Summited Details

Name:

{{salutation}} {{name}}

Last Name:

{{surname}}

Email id:

{{email}}

Care of:

{{careof}}

Father's / Mother's / Spouse's Name Name:

{{fHName}}

Candidate’s Mobile No:

{{phoneNumber}}

Alternate No:

{{alternatePhoneNumber}}

Date of Birth:

{{dob}}

Marital status:

{{maritalStatus}}

Gender:

{{gender}}

Address:

{{address}}, {{city}}, {{state}} - {{zip}}

Passport Number:

{{passportNumber}}

Passport Issue:

{{passportIssue}}

Passport Expiry:

{{passportExpiry}}

Appointment Fee:

{{fee}}

Vaccination Type:

{{vaccination}}

Dose 1:

{{dose1}}

Dose 2:

{{dose2}}

Dose 3:

{{dose3}}

Dose 4:

{{dose4}}



Submitting Information...