Franchise Request Form
Is your application for a
Single Centre Franchise
Multiple Centre Franchise
Infrastructure Details
Please Tick Whichever Is Relevant
Are your premises in a Residential or Commercial Area?
Residential
Commercial
Is it owned by you?
Yes
No
The Sq. feet area within which you plan to start a “Medanta Lab”.
Sq ft.
Who will look after the Centre?
Myself
Family Member
Administrator
What income-group of people reside within 2 Km. radius from where you intend to start the centre?
High
Middle
Lower Middle
Mixed
Are you opening a Single Franchise Centre or Multiple Franchise Centers?
How many house hold are available in 2 Km. radius of center.
Location/s of your Center
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