Eye Donation registration form


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Dear Donors, Please fill the following information to register.

Eye Donation Registration Form
***Now only in Kerala***


	* =mandatory	back
	Personel Details
	* Full Name
	* Age
	* Sex	Male Female
	Mobile Phone
	Contact Phone
	email ID

	Personel Contact
	* Home Address
	Residence Phone
	* PIN Code
	* State
	* District
	* Place

1.What is an Eye Donation?
Donating eyes after death.

2.Who can be an eye donor?
Anyone. Cataracts, poor eye sight and age do not prohibit you from becoming a donor. Prospective donors should indicate their intention on donor cards and driver's licenses. Perhaps the most important single thing you can do is make your next of in aware of your wishes to make sure they are carried out.

3.Who can donate eyes?

Eye donors could be of any age group or sex.
People who use spectacles-diabetics, patients with high blood pressure, asthma patients and those without communicable diseases can donate eyes.

Persons with AIDS, Hepatitis B and C, Rabies, Septicaemia, Acute leukemia (Blood cancer), Tetanus, Cholera, and infectious diseases like Meningitis and Encephalitis cannot donate eyes.

	* Please allow 60 to 80days for the delivery of your eye pledge card.
	I confirm that the details given by me are correct. I am willing to donate my eye free of cost without any consideration. I am willing and ready to donate my eye to any person without reference to race, caste, sex, creed or color.