ALL INDIA JAIN YOUTH FEDERATION'S (R)
Bhagawan Mahaveer Jaipur Limbs and Calipers Center
KIMS Premises, Vidyanagar,
Hubli - 580 031.
Tel : 0836 - 2272498.
Regd Office : Hirepeth Hubli - 580 031.
Tel : 0836 - 362151, 366730
Fax : 0836 - 368988.
Enter your details in the form below.
Name of the patient:
Full Postal Address:
Sex:
Male
Female
Age of Patient:
Occupation:
Monthly Income:
Nature of defect:
polio
Above Knee
Below Knee
Other
Other Dieses:
Phone Number with STD code:
Have you secured limb in any Previous camp, if so, Details:
Place:
Date:
