Already registered?
Forgot password?
Login
New Patient Registration
Mr
Mrs
Ms
Miss
Mx
Dr
Prof
Type of care
Please select
Functional Medicine Doctor
Functional Medicine Nutrition
Health Coaching
Phlebotomy
Kundalini Yoga/Tapping
Welcome Appointment
Vitality Check Appointment
Unsure
Date of birth
Sex
Male
Female
Other
Born as
Male
Female
Country Dial Code
Afghanistan (+93)
Albania (+355)
Algeria (+213)
American Samoa (+1 684)
Andorra (+376)
Angola (+244)
Anguilla (+1 264)
Antigua and Barbuda (+1 268)
Argentina (+54)
Armenia (+374)
Aruba (+297)
Australia (+61)
Austria (+43)
Azerbaijan (+994)
Bahamas (+1 242)
Bahrain (+973)
Bangladesh (+880)
Barbados (+1 246)
Belarus (+375)
Belgium (+32)
Belize (+501)
Benin (+229)
Bermuda (+1 441)
Bhutan (+975)
Bolivia (+591)
Bosnia and Herzegovina (+387)
Botswana (+267)
Brazil (+55)
British Indian Ocean Territory (+246)
British Virgin Islands (+1 284)
Brunei (+673)
Bulgaria (+359)
Burkina Faso (+226)
Burundi (+257)
Cambodia (+855)
Cameroon (+237)
Canada (+1)
Cape Verde (+238)
Cayman Islands (+ 345)
Central African Republic (+236)
Chad (+235)
Chile (+56)
China (+86)
Christmas Island (+61)
Cocos [Keeling] Islands (+61)
Colombia (+57)
Comoros (+269)
Congo - Brazzaville (+242)
Congo - Kinshasa (+243)
Cook Islands (+682)
Costa Rica (+506)
Côte d’Ivoire (+225)
Croatia (+385)
Cuba (+53)
Curacao (+599 9)
Cyprus (+537)
Czech Republic (+420)
Denmark (+45)
Djibouti (+253)
Dominica (+1 767)
Dominican Republic (+1 849)
Ecuador (+593)
Egypt (+20)
El Salvador (+503)
Equatorial Guinea (+240)
Eritrea (+291)
Estonia (+372)
Ethiopia (+251)
Falkland Islands (+500)
Faroe Islands (+298)
Fiji (+679)
Finland (+358)
France (+33)
French Guiana (+594)
French Polynesia (+689)
Gabon (+241)
Gambia (+220)
Georgia (+995)
Germany (+49)
Ghana (+233)
Gibraltar (+350)
Greece (+30)
Greenland (+299)
Grenada (+1 473)
Guadeloupe (+590)
Guam (+1 671)
Guatemala (+502)
Guinea (+224)
Guinea-Bissau (+245)
Guyana (+595)
Haiti (+509)
Honduras (+504)
Hong Kong SAR China (+852)
Hungary (+36)
Iceland (+354)
India (+91)
Indonesia (+62)
Iran (+98)
Iraq (+964)
Ireland (+353)
Israel (+972)
Italy (+39)
Jamaica (+1 876)
Japan (+81)
Jordan (+962)
Kazakhstan (+7 7)
Kenya (+254)
Kiribati (+686)
Kuwait (+965)
Kyrgyzstan (+996)
Laos (+856)
Latvia (+371)
Lebanon (+961)
Lesotho (+266)
Liberia (+231)
Libya (+218)
Liechtenstein (+423)
Lithuania (+370)
Luxembourg (+352)
Macau SAR China (+853)
Macedonia (+389)
Madagascar (+261)
Malawi (+265)
Malaysia (+60)
Maldives (+960)
Mali (+223)
Malta (+356)
Marshall Islands (+692)
Martinique (+596)
Mauritania (+222)
Mauritius (+230)
Mayotte (+262)
Mexico (+52)
Micronesia (+691)
Moldova (+373)
Monaco (+377)
Mongolia (+976)
Montenegro (+382)
Montserrat (+1664)
Morocco (+212)
Myanmar [Burma] (+95)
Namibia (+264)
Nauru (+674)
Nepal (+977)
Netherlands (+31)
Netherlands Antilles (+599)
New Caledonia (+687)
New Zealand (+64)
Nicaragua (+505)
Niger (+227)
Nigeria (+234)
Niue (+683)
Norfolk Island (+672)
North Korea (+850)
Northern Mariana Islands (+1 670)
Norway (+47)
Oman (+968)
Pakistan (+92)
Palau (+680)
Palestinian Territories (+970)
Panama (+507)
Papua New Guinea (+675)
Paraguay (+595)
Peru (+51)
Philippines (+63)
Poland (+48)
Portugal (+351)
Puerto Rico (+1 939)
Qatar (+974)
Réunion (+262)
Romania (+40)
Russia (+7)
Rwanda (+250)
Samoa (+685)
San Marino (+378)
Saudi Arabia (+966)
Senegal (+221)
Serbia (+381)
Seychelles (+248)
Sierra Leone (+232)
Singapore (+65)
Slovakia (+421)
Slovenia (+386)
Solomon Islands (+677)
South Africa (+27)
South Georgia and the South Sandwich Islands (+500)
South Korea (+82)
Spain (+34)
Sri Lanka (+94)
Sudan (+249)
Suriname (+597)
Swaziland (+268)
Sweden (+46)
Switzerland (+41)
Syria (+963)
Taiwan (+886)
Tajikistan (+992)
Tanzania (+255)
Thailand (+66)
Timor-Leste (+670)
Togo (+228)
Tokelau (+690)
Tonga (+676)
Trinidad and Tobago (+1 868)
Tunisia (+216)
Turkey (+90)
Turkmenistan (+993)
Turks and Caicos Islands (+1 649)
Tuvalu (+688)
U.S. Virgin Islands (+1 340)
Uganda (+256)
Ukraine (+380)
United Arab Emirates (+971)
United Kingdom (+44)
United States (+1)
Uruguay (+598)
Uzbekistan (+998)
Vanuatu (+678)
Venezuela (+58)
Vietnam (+84)
Wallis and Futuna (+681)
Yemen (+967)
Zambia (+260)
Zanzibar (+255)
Zimbabwe (+263)
Preferred number
Home
Mobile
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua & Barbuda
Argentina
Armenia
Aruba
Ascension Island
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia & Herzegovina
Botswana
Brazil
British Indian Ocean Territory
British Virgin Islands
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Canary Islands
Cape Verde
Caribbean Netherlands
Cayman Islands
Central African Republic
Ceuta & Melilla
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo - Brazzaville
Congo - Kinshasa
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czechia
Côte d’Ivoire
Denmark
Diego Garcia
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Great Britain
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong SAR China
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao SAR China
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar (Burma)
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Korea
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestinian Territories
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Pseudo-Accents
Pseudo-Bidi
Puerto Rico
Qatar
Romania
Russia
Rwanda
Réunion
Samoa
San Marino
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia & South Sandwich Islands
South Korea
South Sudan
Spain
Sri Lanka
St. Barthélemy
St. Helena
St. Kitts & Nevis
St. Lucia
St. Martin
St. Pierre & Miquelon
St. Vincent & Grenadines
Sudan
Suriname
Svalbard & Jan Mayen
Sweden
Switzerland
Syria
São Tomé & Príncipe
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad & Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks & Caicos Islands
Tuvalu
U.S. Outlying Islands
U.S. Virgin Islands
Uganda
Ukraine
United Arab Emirates
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Wallis & Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Name & Practice of Your GP*
Your GP Phone Number
I agree with the Privacy notices of
Dr Indra Specialist Functional Medicine Practice
and
Function 365
,
the Dr Indra Specialist Functional Medicine Practice
Practice Office Policy
and the Function 365
End User License Agreement (EULA)
.
Yes, I'd like to receive periodic emails from Dr Indra Specialist Functional Medicine Practice like health news, tips and offers
Basic info
Preferred name/nickname
None
Internet search
Our Clinic Website
Newspaper Advert
Saw An Outdoor Advert
Insurance Plan
Facebook
LinkedIn
Instagram
Google Maps
Family or Friend
Other
Referral email
Register
×
×
×
×
×
Are you sure?
No
Yes
Yes & Send Message
×