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Currently Staying in? (State) (required)
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Date of Birth
Time of Birth (required)
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Blood Group (required)
Height Ft(required)
Weight (required)
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About me (required)
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Annual Income (required)
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Mother's Name (required)
Number of Siblings
Contact Person's Full Name (required)
Relation (required)
Contact Mother/Father (required)
Thalassemia (Major/Intermedia)MajorIntermedia

Transfusion FrequencyOnce in a weekOnce in 15 daysOnce in a monthNot transfusion dependant
Serum ferritin (required)
Any other Medical Conditions DiabetesThyroidOsteoporosisNone

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