The details that you are going to submit, will be added to our online Directory of Palliative Centres across India. You are requested to fill up this form carefully with correct details so that we are able to provide people with correct information. Thank you.

    Palliative Care Centre Details

    Please fill up this form to submit details of a new Palliative Care Centre or to rectify details of a Palliative Care Centre already enlisted in our directory.

    Please submit as much details as you can so that it helps people find the Palliative Centre.

    If you have information about more than one Palliative Care Centre, you can submit them one at a time. This means that this form can take information of one Palliative Care Centre at a time.

    Example: For submitting information about 3 Palliative Care Centres, please fill up and submit this form 3 times with information of 1 different Centre each time.


     I want to correct details of a Palliative Centre already enlisted in the directory. I want to submit details of a new Palliative Centre for the directory.
































      (MS Word, Power Point & PDF files only. Maximum size allowed: 20 MB.)

     

    -------------------------- Sender's Details ------------------------------------------------------------------------

     







    Please prove you are human by selecting the cup.