Request a Hospital Bed If you are looking for a hospital bed, please submit the below request form. We will revert back to you for verification at the earliest and take your request forward. Please enable JavaScript in your browser to complete this form.SRF ID (13 digit number) *BU Number (6 digits, Only for Bangalore)Patient's Name *Patient's Gender *MaleFemaleIntersexPatient's Age (years) *Patient Mobile Number (Optional) *Patient's Address/Location *Area Pin Code *Attender's Name *Attender's Mobile Number (Required) *Covid Test Done? *YesNoIf Yes, Covid Test Result? (Optional)+ve-veSymptoms/ health status (Optional)SPO2 / Oxygen Level without support *If on Oxygen support, mention Oxygen level (Optional)Co-morbidities, if any (Optional)Bed type required *General OxygenHDUHDU-OxygenICUICU+NIVICU+VentilatorFor how many days searching for the bed?List of visited hospitalsCurrently at home/Hospitals? *HomeHospitalIf at hospital, name of Hospital (Optional)Preferred Hospital *GovernmentPrivateAny Reference of Doctor, if anyIf CT Scan done, provide CT readingRegistered with 108? (Only for Bangalore)YesNoRegistered with 1912? (Only for Bangalore) YesNoYour EmailYour messageSubmit Bed Request