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Representation Request
contact
Registeration for Treatment
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Registeration for Treatment
Registeration for Treatment
1
step 1
2
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Representation
Russia
Iraq
Erbil
Syria
Afghanistan
Azerbaijan
Oman
Iran
Turkey
Pakistan
Emirates
other
First name/Last name
Gender
Male
Female
Birthday
Date Format: MM slash DD slash YYYY
Age
Origin Country
Marital Status
Single
Marriage
Passport Expiry Date
Date Format: MM slash DD slash YYYY
Passport Number
Job
Phone Number
Landline Phone
Email
Social Media
Title of the disease
Description of the disease
Medical records
If you know your vaccination history before entering Iran, specify it
Typhoid
Rabies
Tetanus
BCG
Mumps
Yellow fever
Hepatitis A
Hepatitis B
Pertussis
Black cough
Chicken pox
Polio
Diphtheria
Rubella
If you have specific symptoms, please let me know
Headache
Blood vomiting
Body or muscle pain
Caught
Stomach or abdominal pain
Bone fracture
Fever
Red skin spot
Skin scarring
sore throat
Weakness and lethargy
Shortness of breath
diarrhea
Inflation of the legs or hands
blurred vision
Hair loss
Redness or swelling of the joints
Weight loss
Anorexia
In the wake of a joint
Rhinorrhea
Drowsiness or decreased consciousness
Scan and attach your medical records
Photo by therapist
passport picture
Agency code
security code
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