Doctor Registration - HealthAlpha

Personal Information

Name

Full Name *

Gender *

Mobile Number *

Alternate Number

Email Address *

Residential Address *

Profile Image Upload a professional profile photo (JPG, PNG)

Specialty

Specialization *

Registration Number *

Registration Council *

Year of Registration

Year of Registration (Full)

Years of Experience *

Degree/Qualifications *

University *

Year of Passing *

Current Clinic/Hospital Name

Clinic Address *

Working Hours

Consultation Type

Online Consultation Fee (₹) *

In-Person Consultation Fee (₹) *

Account Holder Name *

Bank Name *

Account Number *

IFSC Code *

Declaration Date *

Please upload all required documents. You can upload multiple files for each document type.

Medical Registration Certificate * Upload your medical registration certificate (JPG, PNG, PDF, DOC, DOCX)

Degree/Qualification Certificates * Upload your degree certificates (MBBS, MD, etc.) - Multiple files allowed

ID Proof (Aadhar/PAN/Passport) * Upload your ID proof document (JPG, PNG, PDF)

Address Proof * Upload your address proof (JPG, PNG, PDF)

Bank Statement/Cancelled Cheque Upload bank statement or cancelled cheque (JPG, PNG, PDF)

Other Documents Upload any other relevant documents (JPG, PNG, PDF, DOC, DOCX)

Additional Documents (Legacy Field) Single document upload for backward compatibility

Username *

Password *

Confirm Password *

I agree to the Terms and Conditions and Privacy Policy *