Patient Referral

Use the form below to refer a patient to us. Fill it out with detailed information for easier assessment. 

Names of Biological Parents


Parents' Physical Address


Patient's Information


History & Patient's Current Situation

Drop your file here or click here to upload You can upload up to 1 files.
Drop your file here or click here to upload You can upload up to 3 files.

ACDIPE is a registered Non-Profit Organization located in Kagoma along Bombo Road in Wakiso District.

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