Saamarthya - COVID Patient Form
Hey,

We know these are trying times & will try our best to support you every step of the way in taking care of you and/or loved one.

We will try our level best to connect you with a donor that is located in your vicinity to ensure the donation is as convenient as possible for you, at the earliest opportunity.

Hope you and/or your loved one gets well really soon. You are a true warrior 🔥! Please take care of yourself as well, don't tire yourself out & stay safe!

Inserting a few links here in case you want to reach out to us!
Email Address- saamarthyavolunteers@gmail.com
Instagram- @_saamarthya_ https://instagram.com/_saamarthya_?igshid=10747er3dz6uo 
Twitter- @_saamarthya_ https://twitter.com/_Saamarthya_
Facebook- https://www.facebook.com/Saamarthya-104818407939403/

You may also visit our website and check out our work under Project Vinita further: https://saamarthya.wixsite.com/saamarthyavolunteers
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Email *
Name *
Type of Requirement (Oxygen, Injection, Plasma, etc) *
Date of Infection
MM
/
DD
/
YYYY
Plasma Requirement, if any  
A+
A-
B+
B-
O+
O-
AB+
AB-
Any
Blood Group
Other Requirement, if any
Locality *
City *
State *
Contact Person *
Contact Number *
Additional Comments, if any
A copy of your responses will be emailed to the address you provided.
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