Refer a Patient
Here is the opportunity for you to help the patients in your acquaintances, who needs treatment abroad. Kindly fill in the following details. We will help the patient get world class treatment from the right place at the right time, or even a medical second opinion.
* Your Name
Title
Organization
Designation
Address
* Telephone
* Mobile
Fax
Email
 
* Name of the Patient
Address
* Telephone
* Mobile
Fax
Email of the Patient
* Treatment Required
Other Details
Attach Medical Reports
  
* Fields are mandatory
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