Photos at home

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How to take photos from home:Press next once completed
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Patient Name* This field is required.
First Name
Last Name
3
Date of Birth * This field is required.
Date
Day
Month
Year
4
Current date
Date
Day
Month
Year
5
Age
6
Responsible Party
First Name
Last Name
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Relationship to patient
Mother
Father
Grandparent
Other
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Email* This field is required.
example@example.com
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Mobile Number* This field is required.
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Upload photos * This field is required.A minimum of 6 photos are required
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
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Tags
[object Object]
Should be Empty: