Fatima Life Care Hospital – Patient Admission Form – Umar Medical Institute Complex (UMIC)

Fatima Life Care Hospital – Patient Admission Form

Welcome to Umar Medical Institute Complex & Fatima Life Care Hospital.
To ensure smooth admission and treatment, we request patients and their guardians to fill out the online admission form. This form helps us record your personal details, treatment requirements, and guardian information.

Please note that after filling this form, you will be asked to read and accept the Consent & Undertaking, which confirms your agreement with hospital policies and responsibilities as a guardian.

Patient Information

Patient Name

Father/Husband Name

Gender

Date of Birth

CNIC/B-Form No Number (without (-) hyphens)

Address:

City / District:

Phone (Primary):

Medical Information

Present Illness / Complaint:

History of Illness / Previous Treatment:

Allergies (if any):

Current Medications:

Blood Group:

Referred By (Doctor / Source):

Guardian / Attendant Information

Guardian Full Name

Relation with Patient:

CNIC Number (without (-) hyphens)

Phone Number:

Address:

Undertaking

I certify that the above information is true to the best of my knowledge. I agree to follow hospital rules and cooperate with doctors and staff. I will not hold the hospital responsible for any natural complications, and I understand that results of treatment are subject to Allah’s will.

Umar Medical Institute Complex (UMIC)

Faith-driven medical care for the vulnerable, the forgotten, and the healing. Serving with dignity, compassion, and excellence.

Umar Medical Institute Complex Kapur Wali Road, Near Chand Bagh, Sialkot

عمر میڈیکل انسٹیٹیوٹ کمپلیکس کپور والی روڈ نزد چاند باغ سیالکوٹ

Malkhanwala Road, Opposite Old Ali Wali, Sambarial

سمبڑیال ملکھانوالہ روڈ بالمقابل پرانی الیوالی( سمبڑیال)

UMIC Departments