Photos at home

1
How to take photos from home:Time to take the photos. Press next once completed
2
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
7
Relationship to patient
Mother
Father
Grandparent
Other
8
Email* This field is required.
example@example.com
9
Mobile Number* This field is required.
10
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
11
Tags
[object Object]
Should be Empty: