Application

Fill the application completely. 

                       Submit the application through net by a click over "submit" button at the end of application.

                       Need to submit proof of residence, proof of qualification along with crossed DD to activate your service.

Name :

Date of Birth : DayMonth Year
Qualification :
Reg. No. :
Education :

Degree 

University   

Year of joining  

Year of completion

M.B.B.S.
P.G / Diploma
M.Ch/D.M.

                                   

 Medals / Distinctions :

 Awards :

Papers presented at  National Conferences
Papers presented at International Conferences
Research topics :
Author for any book :
Address :     
Residence   Clinic
Facilities available in your hospital/clinic
Phone :
Mobile :
E-mail :

Do you want Join as               Consultant                

 Referral doctor           Both
Preferable user name : 
Pass word:
   
   

 

For referral doctors  
Are you ready to lose your patient due to lack of specialty or super specialty service in your town yes       no
Do you want ‘CME’ at your home itself without attending conference or leaving practice yes       No
Do you want to undergo training in following subjects : yes       no
If yes,select the course by clicking on the checkbox besides the course  
Ultrasonography     
Laproscopy           
Gastroscopy            
CT Scan                  
Bronchoscopy       
MRI scan                
ERCP                    
Do you have intention to provide high quality care to your patient yes       no
Do you want accurate diagnosis before starting treatment. yes       no
Do you have a computer. yes       no
Do you have Internet facility. yes       no

 

Only for Consultant :  
Specify your consultation fees
Do you want to give training in the following subjects. yes       no
If so, please specify the details of the course you are interested in                 
Modality     

Duration of training 

Fees

Ultrasonography
Echocardiography, 
Laproscopy
Gastroscopy
CT scan,
Bronchoscopy, 
MRI scan, 
ERCP
Any other specify.

For activation of service:

                                         You should submit following

                                         Proof of residence

                                         Proof of qualification ( Photostat copy)

                                         Crossed DD in the favor of edoctorsnet Pvt. Ltd., HYDERABAD