diff --git a/packages/esm-patient-chart-app/src/visit/visit-form/visit-form.component.tsx b/packages/esm-patient-chart-app/src/visit/visit-form/visit-form.component.tsx
index a8e4876bf0..186e4a8ba5 100644
--- a/packages/esm-patient-chart-app/src/visit/visit-form/visit-form.component.tsx
+++ b/packages/esm-patient-chart-app/src/visit/visit-form/visit-form.component.tsx
@@ -120,7 +120,7 @@ const StartVisitForm: React.FC<StartVisitFormProps> = ({
   const { visitAttributeTypes } = useVisitAttributeTypes();
   const [extraVisitInfo, setExtraVisitInfo] = useState(null);
 
-  const [visitFormCallbacks, setVisitFormCallbacks] = useVisitFormCallbacks();
+  const visitFormCallbacksRef = useVisitFormCallbacks();
   const displayVisitStopDateTimeFields = useMemo(
     () => Boolean(visitToEdit?.uuid || showVisitEndDateTimeFields),
     [visitToEdit?.uuid, showVisitEndDateTimeFields],
@@ -243,7 +243,6 @@ const StartVisitForm: React.FC<StartVisitFormProps> = ({
     reset,
   } = methods;
 
-  // default values are cached so form needs to be reset when they change (e.g. when default visit location finishes loading)
   useEffect(() => {
     reset(defaultValues);
   }, [defaultValues, reset]);
@@ -531,7 +530,7 @@ const StartVisitForm: React.FC<StartVisitFormProps> = ({
               },
             );
 
-            const onVisitCreatedOrUpdatedRequests = [...visitFormCallbacks.values()].map((callbacks) =>
+            const onVisitCreatedOrUpdatedRequests = [...visitFormCallbacksRef.current.values()].map((callbacks) =>
               callbacks.onVisitCreatedOrUpdated(visit),
             );
 
@@ -580,6 +579,7 @@ const StartVisitForm: React.FC<StartVisitFormProps> = ({
         return;
       }
     },
+    // eslint-disable-next-line react-hooks/exhaustive-deps
     [
       closeWorkspace,
       config.offlineVisitTypeUuid,
@@ -591,7 +591,6 @@ const StartVisitForm: React.FC<StartVisitFormProps> = ({
       mutateCurrentVisit,
       mutateVisits,
       mutateInfiniteVisits,
-      visitFormCallbacks,
       patientUuid,
       t,
       validateVisitStartStopDatetime,
@@ -660,10 +659,10 @@ const StartVisitForm: React.FC<StartVisitFormProps> = ({
               <div className={styles.sectionTitle}></div>
               <div className={styles.sectionField}>
                 <VisitFormExtensionSlot
-                  name="visit-form-top-slot"
+                  name="visit-form-bottom-slot"
                   patientUuid={patientUuid}
                   visitFormOpenedFrom={openedFrom}
-                  setVisitFormCallbacks={setVisitFormCallbacks}
+                  visitFormCallbacksRef={visitFormCallbacksRef}
                 />
               </div>
             </section>
@@ -732,7 +731,6 @@ const StartVisitForm: React.FC<StartVisitFormProps> = ({
                       {contentSwitcherIndex === 1 && <BaseVisitType visitTypes={allVisitTypes} />}
                     </>
                   ) : (
-                    // Defaults to showing all possible visit types if recommended visits are not enabled
                     <BaseVisitType visitTypes={allVisitTypes} />
                   )}
                 </div>
@@ -774,7 +772,7 @@ const StartVisitForm: React.FC<StartVisitFormProps> = ({
                   name="visit-form-bottom-slot"
                   patientUuid={patientUuid}
                   visitFormOpenedFrom={openedFrom}
-                  setVisitFormCallbacks={setVisitFormCallbacks}
+                  visitFormCallbacksRef={visitFormCallbacksRef}
                 />
               </div>
             </section>
@@ -813,12 +811,12 @@ const StartVisitForm: React.FC<StartVisitFormProps> = ({
     </FormProvider>
   );
 };
-
 interface VisitFormExtensionSlotProps {
   name: string;
   patientUuid: string;
   visitFormOpenedFrom: string;
-  setVisitFormCallbacks: React.Dispatch<React.SetStateAction<Map<string, VisitFormCallbacks>>>;
+
+  visitFormCallbacksRef: React.MutableRefObject<Map<string, VisitFormCallbacks>>;
 }
 
 type VisitFormExtensionState = {
@@ -838,22 +836,21 @@ type VisitFormExtensionState = {
 };
 
 const VisitFormExtensionSlot: React.FC<VisitFormExtensionSlotProps> = React.memo(
-  ({ name, patientUuid, visitFormOpenedFrom, setVisitFormCallbacks }) => {
+  ({ name, patientUuid, visitFormOpenedFrom, visitFormCallbacksRef }) => {
     const config = useConfig<ChartConfig>();
 
     return (
       <ExtensionSlot name={name}>
         {(extension: AssignedExtension) => {
-          const state: VisitFormExtensionState = {
+          const state = {
             patientUuid,
-            setVisitFormCallbacks: (callbacks) => {
-              setVisitFormCallbacks((old) => {
-                return new Map(old).set(extension.id, callbacks);
-              });
+            setVisitFormCallbacks: (callbacks: VisitFormCallbacks) => {
+              visitFormCallbacksRef.current.set(extension.id, callbacks);
             },
             visitFormOpenedFrom,
             patientChartConfig: config,
           };
+
           return <Extension state={state} />;
         }}
       </ExtensionSlot>
diff --git a/packages/esm-patient-chart-app/src/visit/visit-form/visit-form.resource.ts b/packages/esm-patient-chart-app/src/visit/visit-form/visit-form.resource.ts
index 832c9b550f..c62ac2c948 100644
--- a/packages/esm-patient-chart-app/src/visit/visit-form/visit-form.resource.ts
+++ b/packages/esm-patient-chart-app/src/visit/visit-form/visit-form.resource.ts
@@ -1,7 +1,7 @@
 import { openmrsFetch, restBaseUrl, useConnectivity, useVisitTypes, type Visit } from '@openmrs/esm-framework';
 import { type amPm } from '@openmrs/esm-patient-common-lib';
 import { useOfflineVisitType } from '../hooks/useOfflineVisitType';
-import { useState } from 'react';
+import { useRef } from 'react';
 
 export type VisitFormData = {
   visitStartDate: Date;
@@ -28,12 +28,13 @@ export function useConditionalVisitTypes() {
 
   return visitTypesHook();
 }
+
 export interface VisitFormCallbacks {
   onVisitCreatedOrUpdated: (visit: Visit) => Promise<any>;
 }
 
 export function useVisitFormCallbacks() {
-  return useState<Map<string, VisitFormCallbacks>>(new Map());
+  return useRef<Map<string, VisitFormCallbacks>>(new Map());
 }
 
 export function createVisitAttribute(visitUuid: string, attributeType: string, value: string) {
diff --git a/packages/esm-patient-chart-app/src/visit/visit-form/visit-form.test.tsx b/packages/esm-patient-chart-app/src/visit/visit-form/visit-form.test.tsx
index 915fbe0add..4f3fbd9724 100644
--- a/packages/esm-patient-chart-app/src/visit/visit-form/visit-form.test.tsx
+++ b/packages/esm-patient-chart-app/src/visit/visit-form/visit-form.test.tsx
@@ -76,10 +76,11 @@ const mockUseEmrConfiguration = jest.mocked(useEmrConfiguration);
 
 // from ./visit-form.resource
 const mockOnVisitCreatedOrUpdatedCallback = jest.fn();
-jest.mocked(useVisitFormCallbacks).mockReturnValue([
-  new Map([['test-extension-id', { onVisitCreatedOrUpdated: mockOnVisitCreatedOrUpdatedCallback }]]), // visitFormCallbacks
-  jest.fn(), // setVisitFormCallbacks
-]);
+
+jest.mocked(useVisitFormCallbacks).mockReturnValue({
+  current: new Map([['test-extension-id', { onVisitCreatedOrUpdated: mockOnVisitCreatedOrUpdatedCallback }]]),
+});
+
 const mockCreateVisitAttribute = jest.mocked(createVisitAttribute).mockResolvedValue({} as unknown as FetchResponse);
 const mockUpdateVisitAttribute = jest.mocked(updateVisitAttribute).mockResolvedValue({} as unknown as FetchResponse);
 const mockDeleteVisitAttribute = jest.mocked(deleteVisitAttribute).mockResolvedValue({} as unknown as FetchResponse);