Campaign Details Campaign Title* 75 characters left Cover Image* Patient's Story* 2000 characters left NextPatient Information Important: Patient details cannot be changed once submitted. Providing incorrect information may result in donations going to the wrong person. The community has the right to flag your campaign if false details are detected. Please fill in accurate and truthful information. Patient Name* Country* Please set your country in your user profile to continue Contact Number* Enter a valid contact number without country code (9 to 14 digits). Previous NextHospital Information Important: Please provide the correct hospital name and contact number. Community members may verify patient details by personally visiting or calling the hospital. Ensure the phone number is accurate and active, and that calls are received by the hospital. False or unverifiable information may result in your campaign being flagged Hospital Name* Bill Amount* (Minimum: USD 500 — Maximum: USD 70,000) Medical Report (Proof)* Accepted formats: JPG, PNG, PDF Hospital Contact Number* Previous NextBank Details Important: Bank account details cannot be changed after campaign completion. Bank Name* Account Holder Name* Account Number* SWIFT Code (Optional) Previous Submit Campaign
