REPORT on the Child's Treatment for Helpster

Use this form to send information regarding children's finished treatment to Helpster

Country *

Volunteer's name *

Child's First Name *

Child's Last name *

Child's Age *

Hospital (if known)

Where the child lives? (region)

Health Issue *

Child's story *

Parents and their contacts *

Cost of treatment (if known)

Volunteer's Comment

Is it an Urgent case?

Parents signed consents