Sign up Form Your Name* Your Email ID* Plan Interested In * Basic: Rs 22500. Includes - 10 Pages, Basic Information, 1 Video / 1 Image Gallery , Select from 3 TemplatesAdvance: Rs 45000. Includes - Upto 25 Pages, Basic Information + Images/Video Gallery, Select from 5 TemplatesExpert: Rs 67500. Includes - Upto 60 pages, Basic Information+ Mulitple Images/ Video Galleries, Custom Templates Favorite colors or colors associated with the Clinic Enter the name of the color URL of choice (3 in order of preference) e.g. www.drsherkar.com Template of choice Kindly enter the template code Any other instruction/suggestion for the template Name of the Doctors and their brief Enter doctor name and details Specialization/s practiced at the Clinic Enter doctors Specialization/s Name of the Practice or Clinic Enter Clinic Name Clinic Timings/Doctor Timings and their availability Enter timing of the clinic/Doctor Clinic Address & Contact Details Enter Clinic Address & Contact Details (Address, Phone no., Email Id, Mobile No.) Services offered at the clinic Small Paragraph/Description of the service would be nice Equipment and Facilities at the clinic Enter equipment and facilities available at the clinic Social Networking links and Blog Link Enter social Networking/Blog links like facebook, Twitter, Linkedin etc. Payment Mode * Cheque or Draft in the name of: “Plus91 Technologies Private Limited” and Courier to "Plus91 technologies, 501 A, East Court Phoenix Market City, Op. Giga Space, Viman nagar, Pune 411014.Neft or RTGS transfer: Account Name: Plus91 Technologies Pvt Ltd, Bank Code - ICIC000005, A.c no – 000505016504.Deposit Cash in any ICICI Bank for Account:Plus91 Technologies Pvt Ltd, Bank Bund Garden Road Branch Pune, A.c no – 000505016504."