{{ form_widget(medicalform.bariatricSurgery) }} Bariatric Surgery

{{ form_widget(medicalform.treatmentCost) }} Treatment Cost

{{ form_widget(medicalform.citizenship) }} Citizenship

{{ form_widget(medicalform.treatment) }} Treatment

{{ form_widget(medicalform.doctorName) }} Doctor Name

{{ form_widget(medicalform.hospitalName) }} Hospital Name

{{ form_widget(medicalform.hospitalAddress) }} Hospital Address

{{ form_widget(medicalform.beneficiaryName) }} Beneficiary Name

{{ form_widget(medicalform.beneficiaryRelation) }} Beneficiary Relation

{{ form_widget(medicalform.medicalDestinationCountry) }} Destination Country

{{ form_widget(medicalform.medicalDestinationState) }} Destination State

{{ form_widget(medicalform.medicalDestinationCity) }} Destination City

{{ form_widget(medicalform.medicalPlan) }} Medical Plan