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Doctor Registration

    Doctor's Name

    Type

    Medical Council Reg. No.

    Licence Vaild Till

    Clinic or Hospital name

    Qualification

    Specialization

    If Others please specify

    Date of Birth

    Nationality

    Communication Address

    Your Email

    Phone number

    Preferred contact method

    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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