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KT1DP REGISTRATION FORM
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* Indicates required question
Name of the patient
*
Your answer
Date of birth
*
MM
/
DD
/
YYYY
Date of Diagnoses of Type 1 diabetes
*
MM
/
DD
/
YYYY
Current medications
*
Your answer
Name of father
*
Your answer
Name of mother
Your answer
Phone number
*
Your answer
WhatsApp number
Your answer
Email
*
Your answer
Complete Address
*
Your answer
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