Hospital / Healthcare Partner

Hospital Name

Contact Person & Title

Email

Phone

Country

State

City / locality

Website / any link of the facility

Optional

Is your Hospital a Government or Private facility?

GovernmentPrivate

Speciality of the hospital if any

Optional

Number of beds

Do you have operating theatres?

YesNo

Do you treat children?

YesNo

Is your Hospital willing to participate in the charity activities together?

Optional

YesNo

Is your Hospital willing to volunteer on medical and community outreaches in underserved communities?

Optional

YesNo

Are you willing to provide full reports on treated patients, including receipts?

Optional

YesNo

How did you hear about Helpster?

Optional

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PO Box 610226 Newton Highlands, MA 02461