Karkinium Cancer Register

KARKINIUM
CANCER COUNCIL

"Because Every Life Deserves a Tomorrow"

Share your story to support cancer prevention, awareness & research.

SECTION 1: Basic Information

Full Name of Patient

Gender

Date of Birth / Age (at diagnosis)

Current Status

City / District / State / Country

Contact Person’s Name

Contact Number

Select One

Relation with Patient

Family / Genetic History

Any other family member diagnosed with cancer?

If Yes, mention relation & type of cancer

Any genetic / marker tests done?

If Yes, mention test name

Emotional & Financial Impact (Optional)

Did you face any financial crisis during treatment?

If Yes, mention expenses or issues (brief)

Did you receive government or NGO support?

Short message / experience to inspire others (2–3 lines)

Upload Patient Photos

Upload patient reports (You can select multiple)

Consent & Privacy Declaration

I Agree & Submit my information for cancer awareness, research & policy development.

Contact Us

Email: info@karkiniumcancercouncil.com

Helpline: +91-9410220526

Registered Office:
Saharanpur, Uttar Pradesh, India

Support Email: support@karkiniumcancercouncil.com