Admission

Admission Form

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Type of Addiction

Alcohol Tranquilizers Sedatives Opium Heroine BrownSugar Morphine Codeine Pentazocine Buprenorphin Ganja Hash Charas Bhang

Past Withdraw Symptoms

Tremors Insomnia Fits Nausea Aches/Pains

Psychiatric Complications

Depression Suicidal Attempts Confusion Aggressive Outbursts Hallucinations Paronia

Past Medical Illness

Haematemesis Jaundice Abcesses Bleeding Piles Skin Problems Any Other

KGSS Deaddiction Centre
31 M.I.G Janta Nagar
Kanpur, UP 208027

0512 - 3228317

+91 - 9795723570

+91 - 8756724825

contact@kgssdeaddiction.com

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