RIPL AHC program Appointment Registration

Employee Details

1 of 3
Name*
Employee Code*
Company Name*
Gender*
Date of Birth*

DayMonthYear
Date
Age
Department*
Designation*
On RollOff Roll
Work Location*
Phone Number*
Please enter a valid phone number.Format: 00000 00000.
Email*
emailid@company.com
Preferred Location*

Appointment Details

3 of 3
Key Guidance
1. Please note that weekends are heavy booking days at the center.
2. Recommend 1 Weekend preference and 2 weekday options.
3. Packages have been curated based on collaboration with Health and Safety and HR teams.
4. No Shows will be considered as appointment cancelled.
5. Skipping out of any of the modalities during the day of the test will be shown as BLANK in the report for those modalities.
Preferred Date 1*

DayMonthYear
Weekends and weekdays can be selected
Preferred Time 1*
Preferred Date 2*

DayMonthYear
Only weekdays can be selected
Preferred Time 2*
Preferred Date 3

DayMonthYear
Only weekdays can be selected
Preferred Time 3
Timestamp and location
Please verify that you are human*
Should be Empty: