Patients - Superhumans | Hospital for war traumas

Patient Candidate

Prosthetic

Form

If you require prosthetics, please fill out the form below. The form is to be completed by the patient personally, and for children under 18 years of age, a legal representative should complete it.

Bear Grylls

“I am proud to be an Ambassador of Superhumans, a rehabilitation center that supports, helps, and restores your superheroes, veterans, men and women who have given so much for your beautiful country.”

I confirm that I have suffered an injury as a result of military actions on the territory of Ukraine.

Full name^*

Email^*

Phone Number^*

Date of Birth^*

Date of Injury Received^*

A brief description of the injury and the stages of treatment^*

Available medical documentation regarding the injury^*

Current condition and location^*

Upload last medical report

Upload a Photo of Injury

If you wish to provide more documents, please send them to the email [email protected]

By completing and sending this questionnaire on the website superhumans.com, I (personally/my authorized representative) in accordance with the Law of Ukraine “On Protection of Personal Data” grant the Superhumans Charity Fund: Ukraine, 03150, Kyiv city, Velyka Vasylkivska Street, Building 100, voluntary and informed consent for the processing of my personal data indicated in the questionnaire, as well as for the dissemination (including provision, realization, and transfer) of my personal data to third parties for the purpose of organizing charitable assistance.

Requirements for patients

We only provide prosthetic services to Ukrainian citizens who can provide documents confirming their identity and Ukrainian citizenship.
We accept military and civilian patients who are at least 18 years old.
Children can be considered for treatment from 2 years old after the opening of the hospital ward (after 04.10.23) and must be accompanied by their parents.
Consent to medical intervention provided by the Superhumans medical team is required.
Patients must agree to follow the center’s schedule, attend psychologist sessions, and complete a rehabilitation course after prosthetic treatment.
We do not accept patients with alcohol or drug addiction.
Our center reserves the right to refuse treatment based on medical indications.