Customer Details – Aarogya Healthcare

Pay

Name *

Email *

Phone number 1 *

Phone number 2

Plan Name *

Name on the card 1

Name on the card 2

Address

Name on the card 3

Landmark

Name on the card 4

City

Name on the card 5

Pincode

Name on the card 6

ORDER DETAILS

I hereby agree that Aarogya India healthcare services is permitted to contact me through SMS/Email /Telephonic communication even if I am registered on the National DNC or any other DNC/ DND list. I have gone through all the terms and conditions of the product and I have paid the plan amount myself using my debit/creditcard/ other payment mode provided to me at the time of opting for the plan