🦷 Teleconsultation Entry Form
📅 1. Teleconsultation Session Details
Consultation ID
Date of Teleconsultation
Time
Dentist Name
Location (Doctor)
Mode of Teleconsultation
--Select--
Phone
WhatsApp Chat
👤 2. Patient Information
Patient Name
Age
Gender
--Select--
Male
Female
Other
Contact Number
Location (Patient)
📝 3. Consultation Details
Chief Complaint
Findings (Preliminary)
Recommended Treatment
Referral Needed?
--Select--
Yes
No
Referred to (Clinic/Hospital)
✅ 4. Conversion Tracking
Did Patient Convert to In-Person?
--Select--
Yes
No
Date of Appointment
Procedure Done
Revenue from Conversion (₹)
Feedback from Patient
Submit