Please Register as solo Practitioner
*
Registration Details
:
*
Council Name :
*
Year of Registration :
Please select year of registration
*
Registration Number :
*
Personal Details
:
*
First Name :
*
Last Name :
*
Qualification :
*
Specialty :
*
Mobile No. :
*
E-mail :
*
Facility Details
:
*
Name of the facility :
*
Address Line1 :
Address Line2 :
*
City :
*
Area :
*
Pincode :
*
State :
Consultation Fees :
Will the fees be displayed to be viewed by patients ?
Yes
No
Would you also like to use the fees to generate and track bills of patients ?
Yes
No
*
Preferred Username
:
Registration completed successfully. Please check your email for login credentials. Thank You!
Opps... Something went wrong please contact the Aptsource team to report the problem.
