Patient Admission & Consent 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

Address Details

Contact Information

Guardian/Attendant Information

A simplified version of the Urdu paragraph from the form, e.g.:
"I hereby declare that the information provided is true. I agree to follow all hospital rules and regulations. The hospital administration will not be responsible if the patient leaves without permission or against medical advice. I understand that financial assistance (Zakat/Relief) is only for eligible patients as per policy. I take full responsibility as the guardian of the patient."

Guardian Consent Section

Witness Information

Witness 1:
Witness 2:

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

Fatima LifeCare Hospital

Fee Sabeel Allah Nursing Care Shelter

Umar Rehab Center

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Contact

0310-7181122

fwfsialkot@gmail.com

NRSP EasyPaisa Account #:

008210000075

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