Doctor's Registration
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Are you a doctor? Aren't you registered yet?
Register for your own scheduling, appointment and prescription website.
Personal Info.
Name
[Required]
Father's Name
[Required]
Gender
[Required]
--select your gender--
Male
Female
Other
Cell Phone No.
[Required]
Email
[Required]
Website, Login & business Info.
Website's Subdomain
[Required]
www.
.evisit.live
Check availability of subdomain
check, available or not!
User Name
[Required]
Reference By
Password
[Required]
Confirm password
[Required]
Professional Info.
Doctor Type
[Required]
--select Doctor Type--
Medical
Dental
Registration Authority
[Required]
--select Registration Authority--
BMDC
DGHS
Registration Number
[Required]
Degrees & Certifications
[Required]
Specialties
[Required]
Present/Last Job Details
[Required]
Membership
[Required]
Practice Start Year
[Required]
minutes
Examination Time
[Required]
minutes
Visit Fee
[Required]
Report Showing Fee
[Required]
Visit Fee
[Required]
within
days after the last visit
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