Doctors’s Sign up Form
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Title
Name
Specialty
Qualification
Registration No.
(or CNIC No. in case of no registration No.)
Registration authority
Diseases, you are interested in
Associations and Memberships
Research Work
Name Of Clinic
Your Fees at this clinic.(In Rs.)
Clinic Address
Clinic Location On Map
Clinic timings (Monday)
Clinic timings (Tuseday)
Clinic timings (Wednesday)
Clinic timings (Thursday)
Clinic timings (Friday)
Clinic timings (Saturday)
Clinic timings (Sunday)
Name Of Clinic
Your Fees at this clinic.(In Rs.)
Clinic Address
Clinic Location On Map
Clinic timings (Monday)
Clinic timings (Tuseday)
Clinic timings (Wednesday)
Clinic timings (Thursday)
Clinic timings (Friday)
Clinic timings (Saturday)
Clinic timings (Sunday)
Online Consultation charges.(In Rs.)
Availability timings
Weak Days
Home visit charges.(In Rs.)
Availability timings
Weak Days
Cell No. (Mobile phone)
Date Of Birth
Languages you can communicate in:
Country, you belong to.
City, You Belong To
City of your current residence.
National Identity Card No. / Passport No.
Institution / Hospital
Department
Unit
Your Designation
Institution / Hospital
Unit
Department
Your Designation
Email
Whatsapp
Facebook
Instagram
Twitter
Any Other
Name Your Website. idlcare.com/dr/ . . .
Send your Name and Speciality + "Form submitted" to IDLcare's Whatsapp number 03357900123.
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+92 335 790 0123
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