COCHLEAR IMPLANT

     Patient Information

  Patient Name:
  Father's Name
  Date of Birth (Child) *(Age must be less than 05 years)
  Patient Gender

  Contact No.
  E-mail
  CNIC No. (Father)
(11111-1111111-1)
  Form B
  Address:
  Province:
  District:
  Recommended By (Hospital/Board):

 

For further information and queries: ad.it@pbm.gov.pk