Registration Form

Apply for Your Global Thalassemia Card (GTC)

Apply for Your Global Thalassemia Card (GTC) Today

The Global Thalassemia Card is a unique identification card that not only gives you recognition of being a Thalassemia patient but also recognizes your unique needs and provides access to specialized resources, support, and privileges.
Join our global Thalassemia community, dedicated to promote social integration, empowerment, and enhanced quality of life for individuals affected by the condition.

Registration Form

Fields marked with an * are required

First Name *

Last Name *

Gender *

Date of birth *

Select *

Patient Mobile *

Patient Email *

Home Address

City

Country

Guardian Name (if age below 12) or Emergency Contact Person: *

Contact Person Mobile

Thalassemia Care Centre/Hospital Unit Name *

Branch City & Country

Blood Group

Medication for Chelation

Allergies (if any)