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Hospital on-boarding forms

FREE hospital listing on the platform


FREE patient consultation and planning
FREE Chikitsa team member assistance
Multiple languages. Multiple countries. Only NABH And JCI accredited
hospitals
saurabh@donotreinvent.com

Information Requested
1. List of specialty and pricing
2. Facilities
3. Accreditation
4. Doctors profile
5. Other information including write up about the hospital

Note

Feel free to provide us information requested in any pre made format.

VENDOR ONBOARDING FORMS

Hospital Name
Branch
International Department
Head
Email Id
Phone Number
Representative in-charge
a) Email Id
b) Phone

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SPECIALISATION
For us to generate more leads on the platform you must give us a starting
cost range of all treatments types, where possible. It will help patients not
only compare different hospitals withint India but also overseas. If you
have a standard template then you can send it to us via an
attachment/enclosure. If there are specalities which you wouldnt want to
market internationally then please leave the section blank. A sample is
produced for you. You may quote in USD or the local currency.

SAMPLE

ONCOLOGY

Treatment Cost

Brachytherapy
Chemotherapy
Radiotherapy
Radiation Therapy
Stereotactic Surgery
Bone Marrow Transplant
Soft Tissue Sarcoma Treatment
Basal Cell Carcinoma Treatment
Hodgkin Lymphoma Treatment
Non-Hodgkin Lymphoma Treatment
Melanoma Treatment
Acute Leukemia Treatment
Others if Any :-

NEUROSURGERY
Brain Aneurysm Repair
Brain Tumor Surgery

Treatment Cost

Laminectomy
Lumbar Fusion
Lumbar Microdiscectomy
Peripheral Nerve Surgery
Radiofrequency Spinal Therapy
Others if Any :-

CARDIOLOGY & CARDIAC SURGERY

Treatment Cost

Catheter Ablation - Heart Arrhythmia


Coronary Angioplasty
Coronary Angiography
Defibrillator Implant
Heart Surgery
Coronary Artery Bypass Surgery
Pacemaker Implant
Aortic Valve Replacement
Transcatheter Aortic Valve Implant
Mitral Valve Replacement
Stent Insertion
Ventriculography
Others if Any :-

GASTROENTEROLOGY

Treatment Cost

Polypectomy
Sphincterotomy
ERCP
Endoscopy
Liver Biopsy
Pancreatectomy
Sigmoidoscopy
Others if Any :-

ORTHOPEDICS
Hip Replacement
Knee Replacement
Elbow Replacement
Shoulder Arthroplasty
Bunion Surgery

Treatment Cost

Carpal Tunnel Surgery


Meniscus Surgery
Rotator Cuff Surgery
Tendon Repair
Wrist Arthroscopy
ESWT
Others if Any :-

GYNECOLOGY

Treatment Cost

Cervical Biopsy
Dilation and Curettage
Laparotomy
Hysterectomy
Myomectomy
Oophorectomy
Ovarian Cyst Removal
Laparoscopic Tubal Ligation
Diagnostic Laparoscopy
Gynecology Checkup
Hymenoplasty
Others if Any :-

OPHTHALMOLOGY

Treatment Cost

Laser Eye Surgery (LASIK)


Cataract Surgery
Eye Examination
Glaucoma Treatment
Eyelid Surgery
Eye Muscle Repair
Laser Cataract Surgery
Diabetic Retinopathy Treatment
PRK
Vitrectomy
Others if Any :-

UROLOGY
Ureteral Stone Removal
Kidney Stones Treatment

Treatment Cost

Prostate Surgery
ESWL
Vasectomy
Nephrectomy
TURP
Varicocelectomy
Urology Consultation
Urology Ultrasound
Others if Any :-

DENTISTRY

Treatment Cost

Crowns
Dental Implant
Root Canal
Veneers
Inlays/Onlays
Teeth Whitening
Denture
Dentistry Consultation
Tooth Filling
Tooth Extraction
Dental Bridge
Bone Graft
Braces
Invisalign
Teeth Cleaning
Others if Any :-

FERTILITY TREATMENTS

Treatment Cost

In Vitro Fertilization (IVF)


Artificial Insemination
Fertility Consultation
Hormone Tests
Others if Any :-

PLASTIC AND COSMETIC SURGERY


Facelift

Treatment Cost

Liposuction
Wrinkle Treatment
Dermal Fillers
Breast Implants
Rhinoplasty
Abdominoplasty
Wrinkle Injections
Others if Any :-

FACILITIES
Most international patients have special dietary, religious and other needs
and it is very important for us to tell them details of your infrastructure,
honestly.

SAMPLE

Free Wifi
Interpreter services
Airport pickup
Hotel booking
Private rooms for patients available
Special dietary requests accepted
TV in the room
Mobility accessible rooms
Online doctor consultation
Rehabilitation
Car hire
Family accommodation
Local tourism options
Personal assistance / Concierge
Phone in the room

Visa / Travel office


Caf
Dry cleaning
Laundry
Local transportation booking
Medical records transfer
Medical travel insurance
Pharmacy
Restaurant
Flight booking
Nursery / Nanny services
Parking available
Air ambulance
Business centre services
Dedicated smoking areas
Document legalisation
Entertainment options
Health insurance coordination
International newspapers
Religious facilities
Shop
Shopping trip organisation
Special offer for group stays
Translation services
Welcome Package

CITIES AND BRANCHES

Delhi
Mumbai
Chennai
Kolkata
Hyderabad
Others

ACCREDITATION

National Accreditation Board


for Hospitals & Healthcare Providers

Doctors Profile
Most international patients do a detailed due deligence before planning an
international operation. A major part of the research is getting to know the
doctor who will be operating upon them. We recommend that you give us
detailed profiles of your doctors. Please also include special awards which the
President might have conferred upon them, their educational qualifications, any
special publications, feature in press, patents etc. Please make it very detailed. A
snap shot of sample profile follows. Please attach sheets separately for it.

COMMISSION STRUCTURE (if we dont already


have an agreement)
Ideally we charge our partner facilities 30% commission on total collection (both
treatment and medicines), but we are open to negotiation. We also need an
assurance that prices you offer our patients via our plantform cannot be lower if
they had approached you other wise.

Any thing else which you would want to tell us about your facility
including a write up about the hospital. Please feel free to attach
separate sheets.

Print your full name here.


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