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Red-Flags Alert System Test 5
Doctor Recruitment
First name:
Last name:
Email:
Clinic name:
Doctor's IMC Registration Number:
Issued by the Indian Medical Council
Clinic Appointment Booking Number:
Phone number patients can call to book appointments
Clinic Address:
Full address including street, area, city, etc.
Postal Code (PIN):
Enter a 6-digit PIN code. State and district will be derived automatically.
Clinic Whatsapp Number:
Doctor's Photo:
JPEG/JPG/PNG
Field Rep ID:
Provided by your partner organisation
Submit