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Special Care Provider

Do you or your organization provide services for persons with intellectual and developmental challenges?

If so, we can add you to Swechha – our Special Care Provider databank. That way, you will be visible to more persons with disability who can approach you for care. To join Swechha, please fill out the form below. If you have any questions or would like a member of Team Amrit to contact you, please get in touch with us or call us at 98712 61898.

Empanelment Form for Special Care Providers


    You are a:
    OrganisationProfessionalParent Support GroupDisabled Persons Organisation

    If other, please specify:

    NAME of Professional/ Organisation/ Parent Support Group/ Disabled Persons Organisation:

    CONTACT PERSON’S NAME if Organisation/ Parent Support Group/ Disabled Persons Organisation:

    TYPE, if Organisation:
    Government InstitutionPrivateNGOInternational

    If other, please specify:

    Specialization:

    Clinical Psychology/PsychiatryPhysiotherapyCounsellingAccessibility Services
    Speech TherapyAudiologistVocational InstructionAssistive Aids & Technologies
    Occupational TherapySpecial EducationSocial WorkGeriatric Services


    If other, please specify:

    DISABILITIES WITH WHICH YOU WORK:

    AutismIntellectual DisabilityMultiple Disabilities
    Down SyndromeSpecific Learning Disabilities e.g., Dyslexia, Dyscalculia
    Cerebral Palsy


    If other, please specify:

    Details for Primary location:

    Address (Landmark):

    Pincode (Required)

    Mobile Number (Required):

    Landline Number:

    Email ID (Required):

    Website (URL):

    Working Days:

    All days except SundayWednesdaySaturday
    MondayThursdaySunday
    TuesdayFriday


    Timings:

    Prior appointment required:YesNo

    Referrals (if any):

    Comments about your services (if any):