Register

Pre-Registration – Dhur Health Camp

Please fill in this form before arriving at the camp. It helps the medical team prepare for your visit.

Patient Information

Full Name *

Date of Birth

Gender

Citizen ID Card (CID) Number

Your CID allows us to link your records from previous camps automatically.

Village / Area

District

Mobile Number

Known Medical Conditions

Family Contact

Family Member Name

Family Email Address

Previous Camp

Previous Camp Record ID (if attended before)

If you attended a previous Dhur Health Camp, enter your Record ID to link your history. Your CID (above) will also link records automatically.

Consent

I consent to my medical information being recorded and used by the Dhur Health Camp medical team for treatment purposes. *