Health on Demand - Health Care Professional Sign-Up form

Please input your professional and academic qualifications and choose the keywords under the categories that apply best to your on-call consultation expertise.

Input your first name as it appears in official registration
Input your last name as it appears in official registration
Date of Birth
Gender

Active e-mail address
Please provide phone number for on-call consultations
Education
Please input most relevant degree and certificate details. Add as many fields as necessary.

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Please upload documents related to your education

Practice Location
Enter your primary place of practice eg. Andheri, Mumbai
About
Provide a brief summary of your career, experience and area of expertise. (max 1000 Characters)
Years Of Experience
Please select number of years of relevant experience in the healthcare field

Select All Applicable Registrations (click to view/hide) keyboard_arrow_down

Experience
Input past and present designations, clinics, no. of years. Add as many fields as necessary. (max 150 words)
Awards
Input all relevant awards with awarding bodies. (max 150 words)

Select All Applicable Specializations (click to view/hide) keyboard_arrow_down
You may choose all specializations that you have had some experience in. Choose "other" if unavailable in given options.

Select All Applicable Services (click to view/hide) keyboard_arrow_down
Select multiple keywords under the categories that are relevant to your expertise. Keywords are designed to be patient friendly so select all "complaints" that you can give advice on-call for.

Select All Applicable Memberships (click to view/hide) keyboard_arrow_down
Select medical associations or groups that you are a member of

Documents
Please upload following documents

{{file.name}} X

CV
ID/Address Proof
Other Documents