PatientsCentric

Select provider

Dear physician, please fill out the below registration form.

Please provide the correct details so that we can serve you better.

Username*

Note : Recommendation is to use your Mobile Number or Email ID as your Username so that you can remember, but you can enter anything as your Username.

Mobile Number*

OTP will be sent on email and mobile.

Title* (Dr./Mr./etc)

First Name*

Last Name*

Gender

Age

(YEAR:0 MONTH:0)

Registration

Experience

(YEAR:0 MONTH:0)

Qualification & Speciality

Qualification

Specialization

Qualification(Specialization)

You can add multiple Qualification and Speciality.

Speciality Remarks

Clinic Name*

Availability Notes

Available for Emergency Calls

Address*

Reference Promo Code/Referred by someone, Please enter referrer's username.

Password* (min. 6 char) [This is encrypted]

Confirm Password*

I agree to the Terms of Service and Privacy Policy

Please check if you have filled all the required fields marked with *

District	Pincode	State

Enter your Building Name & Area:

Please verify your address and click on Update

PatientsCentric™

Dear physician, please fill out the below registration form.

Please provide the correct details so that we can serve you better.

Please check if you have filled all the required fields marked with *