JINDAL NATURECURE INSTITUTE
JINDAL NAGAR, TUMKUR ROAD, BANGALORE 560073
Co-patient’s name with Relationship if accompanied
(Submit a separate application)
Date of Birth
Father / Husband’s name
Full Postal Address
Telephone / Mobile
Married / Unmarried
Passport No. Date of Issue Place of Issue
Accommodation Details Browse Tariff Table
Type of Accommodation desired
Total number of days desired
Date from which accommodation Required From : To :
Alternate Date from From : To :
Details of Reservation Deposit
Annual Income from all sources (only in case of
In case of re-admission, please write
Previous date of admission M.R. Number Accommodation
Height Weight BP Appetite Sleep Urination Bowels Menstrual Cycle
Please answer the following:
1 Have you undergone any operation the past 3 months? If yes, give details.
2 Do you suffer for any type of Hernia? If yes, give details.
3 Do you suffer from any kind of skin disease? If yes, give details
4 Have you suffered from Heart ailment in the past? If yes, give details.
5 What medicines are you taking at present?
6 Habits (Tea / Coffee / Smoking/Alcohol / Drug addiction / Zarda / Pan
7 Are you addicted to any substance? If so, give details.
8 Can you walk 1 km without any support? If NO, give details.
9 Are you physically /visually disabled? If so, give details
Note: Please read the rules and regulations by visiting our website:
www.jindalnaturecure.org before submitting this application.
Send reservation deposit equivalent to 3 days accommodation charges of your choice
along with the application by DD in favor of JINDAL NATURECURE INSTITUTE,
payable at BANGALORE.
If you are coming with a co-patient, please send separate application along with the
For Deluxe Nest & Regular Nest booking at least 2 patients are required. Foreigner/NRI
are eligible to apply for Executive Room & above only.
The Institute is not liable if you do not read the rules and regulations
Please use the following link to make online payment:
For further information please visit our website http://www.jindalnaturecure.org