Sanjay Gandhi Post Graduate Institute of Medical Sciences
Raebareli Road, Lucknow - 226 014 ,India
ONLINE REGISTRATION FORM
Reference No. REGOL-668730 [Link] Jun 29, 2026 Department Gastroenterology
Name Mr Rakesh Kumar Singh
Sex MALE Marital Status Married
Date of Birth Nov 1, 1958 Age 67 Yrs Email [Link]@[Link]
Religion Hindu Occupation Others Mobile 9336204544
Address(Permanent) Urban Address(Correspondence) Urban
House No 61C House No 61c
Street/ Village Pura Dalel Near Bsnl Office Street/ Village Pura Dalel Near Bsnl Office
Locality/P.O Tilak Nagar Locality/P.O Tilak Nagar
City/ District Allahabad City/ District Allahabad
State Uttar Pradesh State Uttar Pradesh
Pin 211006 Pin 211006
Phones Phones
Nearest Rly. Stn. Prayagraj Sangam Nearest Rly. Stn. Prayagraj Sangam
Emergency Contact Gaurav Singh Relationship Others Emergency Phone 9519250140
Ref. Doctor Rk Maurya Ref. Hospital Navgrah Ref. Department Gastroenterology
Hospital
Mahewa Dandi
Allahabad
Identity Type Adhar Card Identity No 543817842322 Issuing Authority Government
Please report to the online registration counter before 10.00 AM with your referral documents with this online registration
[Link] is valid upto Sun Jul 26 2026 only
1. I/My patient am/is fully aware that this registration is only for O.P.D consultation and this does not qualify for admission
in Emergency Ward.
2. Report to the Reception Counter with this form duly filled along with referral documents and investigation report before 12:
00 noon.
3. In all those departments where no of registration is limited,it may not possible that the patient will be seen on that day.
However ,the patient will be given next possible O.P.D appointment date.
Signature of Patient/Relative
Printed on 26-6-2026 18:56:27 null@null Page 1 / 1