Aashayein - Let’s Celebrate Life Registration Form
Name of Patient
Mobile Phone Number
Talent you wish to showcase
Getting Hemodialysis where?
Number of attendes other than patient (note that 1 attender per patient is free, more than 1 is charged at Rs. 750 per person)
Never submit passwords through Google Forms.
This form was created inside of Nephrocare Health Services Pvt Ltd.
Terms of Service