Request a Device | IREF

top of page

Screenshot 2021-01-08 at 4.29.59 PM.png

Thanks for subscribing

HOME
ABOUT US
FREE MEDICAL EQUIPMENT
RESOURCES
- Gallery
- Videos
HEALTHCARE PROJECTS
MORE

Use tab to navigate through the menu items.

Patient Registration Form

We are glad you reached out to us, Fill this up so we can get in touch!

Name of Familly Member

Family Member's Contact no.

Address for Delivery

Medical Device(s)/Equipment Donated

Name of Patient

Family Member's Aadhar Card No.

Family Member's Email

Google Maps link of Address

Quantity of devices/equipments

Patient's Condition

Thanks for submitting!
We’ll get back to you shortly.

Copyright IREF 2021

Call us:

+91 98928 14831

Find us:

Indian Relief Foundation, Sufi Darshan, Malang Wadi, Kalyan East - 421306

bottom of page