Request to put your name on the waiting list
Asterisk (*) means "required"

Basic Infomations


Physical informations

8. Do you have any serious wounds or severe pain around your stump?*
9.Are you currently undergoing hemodialysis?*
10. Is it already 30 days or more since your amputation?*

Your Hospital and Doctor

for Amputation surgery

for daily/regular consultation/treatment



© 2019 Instalimb, Inc. All right received.

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