Admission Form

Kripa Revival Centre

Admission Date :
Time :
Name of the Patient :
Age :
Education :
Marital Status :
No. of Children :
Residential Address :
Telephone No. :
Permanent Address :
Telephone No. :
Parent / Spouse Name :
Referred By :
Person to be contacted in case of emergency :
Relationship :
Address :
Telephone No. :
History of Addiction :Alcohol / Drug :
No. of years used :

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Highlights

Services Overview

Kripa Revival Centre (De- addiction & Rehabilitation) is an exclusive centre enabling those unfortunate incidental addicts to relinquish & lead an independent normal life which they had before developing dependency on drugs or alcohol.

Contact Us

Kripa Revival Centre
De-Addiction & Rehabilitation Centre for Men

Address:No. 1/1, Narayanswamy Building (Opp: Hyderabadi Bawarchi Resturant) Kempegowda Circle Kempegowda Main Road Dasarahalli, H.A. Farm Post Hebbal, Bangalore - 560 024..
Telephone:+91 80 64526462
E-mail: info@kriparevivalcentre.org