:: Pushpagiri Eye Institute ::

Pushpagiri Eye Institute

(A Division of Pushpagiri Vitreo Retina Institute),
241, Uma Plaza Road No: 9, West Maredpally,
Secunderabad – 500 026
Andhra Pradesh , India
Ph No: 040-27804949/5959, 66328299/9299

Madhava Netra Nidhi

When you pledge your eyes for future donation, you are giving the gift of sight. This donation, upon your death, will be used for transplant surgery, research or medical training only. Sometimes, your family members may not know your wish of donate your eyes. To ensure the same discuss this important decision with your companion, family members and close relatives/friends. Then share the satisfaction of having made a difference.

Live Beyond Life: Donate Eyes - Pledge eyes for donation

Eye Donation Pledge Form

*Name of the Donor :

Name of the Donor required.
Only characters.
Enter atleast 2 characters.
You can't enter more than 80 characters.

*Date of Birth :

Date of Birth required.

Date format "dd-mm-yyyy".

*W/H/S/D of :

W/H/S/D required.
Only characters.
Enter atleast 2 characters.
You can't enter more than 80 characters.

*House No :

House No required.
Enter atleast 2 characters.
You can't enter more than 100 characters.

*Street No :

Street No required.
Enter atleast 1 characters.
You can't enter more than 100 characters.

*City/Town :

City/Town required.
Only characters.
Enter atleast 2 characters.
You can't enter more than 100 characters.

*State :

State required.
Only characters.
Enter atleast 2 characters.
You can't enter more than 100 characters.

*Pin Code :

Pin Code required.
Minimum 6 digits.
Maximum 7 digits. Only digits.

*Name of the Companion :

Name of the Companion required.
Only characters.
Enter atleast 2 characters.
You can't enter more than 100 characters.

*Email ID :

Email ID required.
Invalid format.

*Family physicians Name, Address, Telephone number :

Characters Only
Address required.
You can't enter more than 500 characters.

Note: Your laminated eye donation pledge card will be issued with in 15 days. Please carry this card always.

Board of Directors

Vijayanagaram Eye Hospital Presentation

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