Registration

Prayas is a patient support program by Alkem Laboratories Ltd, managed by appointed service providers from RxPONT India Private Limited. Through this program, eligible patients receive free medication assistance along with essential access-related information at no cost.

Patient Online registration form

Role ^*

ABM Contact Number

Location ^*

Your name ^*

Patient Details

Patient Name (As per Aadhar) ^*

Patient Age ^*

Gender: ^*

Female

Male

Other

Patient Contact Number ^*

Doctor Name ^*

Hospital ^*

City/ Zone/ Territory ^*

Enter Pincode ^*

Enter Complete Address ^*

Upload Aadhar