Patent Camp Registration - Narayan Seva Sansthan

Add Patient Form

Step 1: Identity Details

ID Proof Number

Mobile Number

Email

UDID Number

Identity Type *

Camp *

Step 2: Personal Details

Patient Photo

Reg Date *

First Name *

Last Name *

Date of Birth *

Gender *

Father's/Husband's Name

Step 3: Address Details

Category *

Address *

Country *

Pincode *

State *

District *

Identity *

Aadhar Front

Aadhaar Back

Disability Certificate *

Action	Name	DOB	Mobile