Online reception of patient admission requests  (permanent pacemaker implantation)

Shams Hospital forms

Online Reception Form

Personal profile:

male

female

prefer not to say

Married

single

Contact Info:

Social Networks

Medical profile of the patient

Please explain about your illness and request

If you have a history of the disease!

What do you like and hate?

Patient description and request

Link to share medical records related to this disease

Send us your medical records(just Zip file)

How did you get to know us?

Thank you for your time

Get In Touch

Daneshkadeh, URMIA, IRAN

Emergency Call Number:   +984433434490

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