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Doctor Registration

    Doctor's Name


    Medical Council Reg. No.

    Licence Vaild Till

    Clinic or Hospital name



    If Others please specify

    Date of Birth


    Communication Address

    Your Email

    Phone number

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    Languages Known

    Are you willing to join with us as a video consulting Doctor

    What is your expected cost per consultation?

    What are your available timings for Video Consultation?

    Are you comfortable displaying your profile in our website?

    Do you have any Teleconsultation Experience

    Are you working with any other Teleconsultation Platform

    If you work with any other Teleconsultation Platform

    Clinic / Hospital Address ( Associated at Present ) *

    Documents Upload *

    Passport size Photo *

    Signature Scanned copy *

    Additional Information

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