Skin Donation Online Pledge Form

"Call Ganga Hospital skin bank number 0422 2485000 within 6 hours after death for skin donation"

As skin donation can only be done when the next of kin consent, we would like to get the details of your next of kin. We may write to them stating that you would like to donate and ask their permission.

Would you like us contacting them about your decision?
  • Yes
  • No

I,

agree to pledge my skin for donation after my death to Ganga Hospital Skin Bank, Coimbatore. I grant permission for the recovery of my skin after my death for the purposes of transplantation and research as deemed necessary by the Ganga Hospital Skin Bank authorities.

Age
Address
Mobile No
Email of Donor


Kin 1

Kin 2






Within 6 Hours
Donate Eyes To GIVE SIGHT
Donate Skin To GIVE LIFE

Please contact for Skin Donation
Telephone No – 0422 2485000/0422 2485333
Toll free – 1800425 16000

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