Final request for kidney transplant

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Full Name: *

First

Last

Date of Birth: *

Gender: *

Email: *

Phone: *

Country of residence: *

Blood Type: *

Previous transplant experience:

No
Yes

Current Medications:

Medical documents and records:

Click or drag files to this area to upload.You can upload up to 10 files.

Package selection: *

Economic in Iran- 51,000$
Economic in Turkey - 61,000$
Premium in iran - 59,000$
Premium in Turkey - 69,000$
VIP in Iran - 68,000$
VIP in Turkey - 82,000$

How to contact you: *

Email
Phone Call
WhatsApp
Skype
Line

The fastest way for our experts to communicate with you is to use WhatsApp or email.

The desired time range for the start of the operation: *

Choose this option only if you are ready to perform the operation in the next 5 to 15 days

Choose this option only if you are ready to perform the operation in the next 10 to 30 days

Patient's ID card or Passport:

Click or drag a file to this area to upload.

By submitting this form, I acknowledge that:

I have read and understood the conditions for requesting a kidney transplant.
I am financially prepared to cover the costs of the transplant.
I am ready to proceed with the transplant within the specified timeframe.

Your Kidney Transplant Planning Fee:

$0.00

Please note that your kidney transplant procedure will only commence after the payment of the planning fee. This fee will be deducted from the total cost of your chosen package

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