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Personal Details

Name Of Ward *
Email Of Ward *
Gender Male Female
Date Of Birth *
Education

Family Details

Father's name and address and education
Father's profession/occupation
Father's Email ID
Father's Contact Number
Mother's name and address and education
Mother's profession/occupation
Mother's Email ID
Mother's Contact Number
Profession/Occupation of ward
Yearly income of ward
Financial security/assets in the name of ward
Caste
Family members of ward Brother Sister

Psychiatric/neurological problems of ward

Age at which the problem started
Nature of symptoms
Efficiency in doing day to day activity
Details of medications
Diagnosis
Any other physical illness
Details of previous divorce,if any.
Name of treating doctor and his opinion about the marriage of the ward
Treating doctor's certificate about the diagnosis, treatment and functional recovery of the ward.
Family support of the ward.
Names of the caregivers of the ward.
Opinion about having children after marriage. YES NO
Opinion about permanent family planning methods.
Height in CM.
Weight in Kg.
Skin complexion.
Option to marry or live-in relationship. Marry Live-in relationship
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