Register — Faizan Rehabilitation Centre | Faizan Rehabilitation Centre

Child Registration

Faizan Rehabilitation Centre

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Personal Information

Full Name *

Father's Name

Email Address *

Gender

Date of Birth

Age

Password *

At least 8 characters, with letters and numbers.

Confirm Password *

Branch & Contact Information

FRC Branch * Your registration will be sent to the admin of this branch for approval.

Phone Number

WhatsApp Number

Address

Present Complaint Information

Select all present complaints that apply to the child. You can select multiple.

ADHD

Anxiety disorder

Bipolar disorder

Blindness

Cerebral palsy

Club foot

Deaf

Down syndrome

Epilepsy

Hearing problem

Intellectual limitation

Physical limitation

Speech disorder

Thalassemia

Other

Please describe the present complaint

Notes & Submit

Parent Notes / Additional Information

Important: After submitting your registration, your account will be pending admin approval. You will be able to login once an admin reviews and approves your registration. An email will be sent to you once your account is approved.

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