Request treatment in Iran

Share the basics. Your dedicated coordinator will contact you after reviewing the request.

1Details
2Consent
3Submit

Country of residence

Mobile number (WhatsApp)

Enter only the mobile number that has WhatsApp; the country code is filled in from the country you pick. Your coordinator will reach you on this number.

Treatment you need

Describe your situation

Medical documents (optional)

Tests, scans, MRI, prescriptions or a doctor report; you can choose several files at once. They are sent after your request is saved and you can delete them until they are reviewed.

I prefer a female doctor

This form is not a medical diagnosis.