Register – PPMD

Register

Please enter your data to register.

Child/Patient First Name *

Last Name *

User Name *

Patient/Child/Kid DOB *

Age *

Parent/Guardian Name *

Surname *

Mobile No *

Code

Email *

Country *

State *

.

City *

Diagnosis *

DMD

Exon missing nos *

Current medications if any or write NA *

Password *

Repeat Password *

Is physiotherapy done? Yes No

Multiple File Upload
#