Refer a Medical Case

Help us help a family.

Share genuine medical case details. Our responsible team reviews every referral with care and confidentiality.

1 · Patient Details

Patient name *

Age

Gender

Location

Contact number *

2 · Medical Condition

Diagnosis / situation *

Has the diagnosis been confirmed?

YesNoDon't know

Department / specialty needed

How urgently is help needed?

Doctor name (if any)

3 · Current Hospital & Care

Current hospital

Is the patient currently admitted to a hospital?

YesNoDon't know

Does the patient need to be admitted?

YesNoDon't know

Is ICU required?

YesNoDon't know

Is a ventilator required?

YesNoDon't know

Are blood / platelets required?

YesNoDon't know

Is an ambulance required?

YesNoDon't know

4 · Support Needed

You can choose one or more options.

Doctor guidanceHospital / doctor coordinationFinancial supportICU / bed coordinationBlood / platelets supportAmbulance supportMedicine supportSecond opinionGovernment scheme guidanceVolunteer supportOther

5 · Financial Status

This helps the KFT team with case verification and prioritising support. Bank details will only be requested after case verification.

Family financial status

Government scheme (if any)

Family has an Ayushman / health card

Estimated treatment cost (₹)

Amount required (₹)

Amount already arranged (₹)

6 · Documents & Referrer

Upload medical documents

(e.g. prescription / doctor note, medical report, hospital estimate, patient ID proof, Ayushman / health card if available, and photo / video only if necessary)

Please upload only the necessary documents. Your sensitive information will be kept confidential by the KFT team.

Referred by

7 · Consent & Declaration

I consent to KFT sharing these details for case review with doctors / core team / volunteers.I consent to KFT contacting the family / referrer directly.I understand that KFT attempts to provide medical guidance, coordination and support, but this is not a replacement for emergency medical services or hospital treatment.I confirm that the information shared is true to my knowledge.

By submitting this form, you agree to KFT's Privacy Policy and Terms & Conditions.

Kiran Foundation Trust

A Mother's Blessing

A community-driven medical support initiative helping families during difficult healthcare situations with timely guidance and compassionate care.

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+91 8210665259
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care@kiranfoundationtrust.org
India

Made with care for families in need.