Name of Compplaint*
Gender* MaleFemale
Father/Mother Name
Cast (SC/ST)
Cource (in case of student) -Select One-ANMGNMBSC(N)Post Basic(N)Vet Pharmisist
Year of Admission (in case of student)
Semester (in case of student) -Select One-1st2nd3rd4th5th6th7th8th
Brief Particular Complaint*
