Red-Flag Alert System
Doctor Recruitment
First name
*
required
:
Last name
*
required
:
Gender
*
required
:
Select gender
Male
Female
Email
*
required
:
Clinic name
*
required
:
Doctor Number
*
required
:
Phone number used to identify and onboard the doctor in the Field Rep flow.
Doctor's IMC Registration Number
*
required
:
Issued by the Indian Medical Council
Clinic Appointment Booking Number
*
required
:
Phone number patients can call to book appointments
Clinic Address
*
required
:
Full address including street, area, city, etc.
Postal Code (PIN)
*
required
:
Enter a 6-digit PIN code. State and district will be derived automatically.
Doctor's Photo
Optional
:
JPEG/JPG/PNG
Field Rep ID
Optional
:
Provided by your partner organisation
Submit
Loading