Indian Red Cross Society
Blood Bank Helpline
Send Email
IRCS-NHQ-Address
Please fill this form for Thalassemia Minor (trait) Screening
Select Title —Please choose an option—Mr.Mrs.MissDr.Other
Enter First Name*
Enter Last Name
Select Guardian* —Please choose an option—FatherMotherHusbandWifeOther
Guardian Name*
Select Date of Birth*
Gender* —Please choose an option—MaleFemaleOthers
Nationality* —Please choose an option—IndianNon-Indian
Marital Status* —Please choose an option—MarriedUnmarried
Select Religion* —Please choose an option—HinduismChristianityIslamSikhismJainismBuddhismOthers
Select Community* —Please choose an option—SindhisPunjabisGujaratisMarwardisBengalisSaraswatsGaursOthers
Residential Address*
Zipcode*
Enter Telephone No
Mobile No*
Email Id*
Occupation
History of Thalassemia in Family* —Please choose an option—YesNo
History of blood transfusion* —Please choose an option—YesNo
Marriage among cousins* —Please choose an option—YesNo
Would like to receive report through* —Please choose an option—EmailSMSPhone CallIn-Person
Note:
- Above mentioned information is for analysis purposes only and will be kept confidential.
- In case of a “Positive” result for Thalassemia minor, all family members need to be tested.
- The report of this test will not be valid for any medico-legal case.
I agree to all terms of services
Δ