Medical Care Form

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For patients who cannot afford treatment. Patient details are seen only by our medical team.

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This form is read only by the authorised team for this area. Nothing in it is shown on the website, in reports or to donors.

Your details

Full name*

Father / husband name

CNIC*

Phone*

Village / area*

Tehsil and district*

Documents

Upload your documents* Choose files — see the list of papers for this form

PDF or photo · several files allowed.

I confirm this information is true, and I agree that Upper Hand may contact me about it.

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