N-IFS Booking Form

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N-FIS Booking Form

Kindly provide details for the order booking of N-FIS.

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CLINIC / DOCTOR DETAILS

Doctor Name *

Dr.

Clinic / Hospital Name *

domain

Full Address *

City *

State *

Pin code *

Mobile No. *

+91

Email ID *

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STIMULATION CYCLE DATA

Average no of stimulation cycles per month *

Options stimulation cycles

10-20 check_circle 20-30 check_circle More than 30 check_circle

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ORDER DETAILS

Product

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Quantity Required (Units)

Special Requirement / Remarks

payments

COMMERCIALS

Cost of device ₹ 18,000 /-

Cost per pack (cartridge and adaptor) ₹ 1,500 /-

I hereby confirm my interest and order booking for N-FIS device(s) under launch offer.I understand that allotment is subject to availability and will be on first-come-first-served basis.

⚠️ LIMITED DEVICES AVAILABLE — Orders processed on first-come-first-served basis