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Request form

Dear Honorable Ukrainian Soldiers,

We are representatives of the Medical Help Ukraine organization. Our project, "Back to Life," is designed to provide assistance to those who have suffered serious injuries due to Russian aggression, resulting in the loss of limbs and freedom of movement. Our goal is to offer you free rehabilitation and limb prosthetics services to help you quickly regain a high quality of life after severe injuries.

If you have experienced trauma resulting in limb loss, and at least 5 months have passed since the amputation, and the amputated area is painless and fully healed, we invite you to contact us by filling out the form below. To better understand your individual needs, please provide more information about the injury. This will enable us to assess the most suitable solution for you. We will respond to your inquiry by contacting you within a week.

Requirements and eligibility for the program:

  • Participant in military actions;

  • At least 5 months have passed since the limb trauma;

  • The wound is fully healed.

We are here to help you regain freedom of movement and improve your quality of life.

Thank you for your service, and we look forward to the opportunity to assist you.

Wishing you strength and a speedy recovery.


Back to Life Team

Request form

Additional attached files

Thank you for your time!



Account no.: LT86 7300 0101 8081 7178

Bank: "Swedbank", AB

Bank address: Konstitucijos Ave. 20A, 03502 Vilnius, Lithuania


The purpose of payment: Support


Registration code: 306400584

Address: A.Tumėno str. 4,  Vilnius

Mobile phone:+370 652 77734


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