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Doctors Registration Form
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illaaj is a modest initiative by a group of public health doctors to join hands forming a network of clinicians and specialists all over the world, so that we can be all updated with the
cutting edge technologies and knowledge in the field of medicine in addition to being expert clinicians. We endeavour to promote rational use of medicines & drugs and minimally
invasive interventions weighing the risk involved against the benefits for all patients. In furthering this effort, we invite progressive doctors of all specialities to join hands with us....
What will illaaj do for you?
- Publish your clinic/hospital on maps for easy location
- Refer patients requiring your services for examination and treatment
- Send patients with their medical history to you for examination, tests, treatment & follow-up
- Provide e-mail accounts to you on request
- Periodic News and updates on medical events and topics including new drug and procedure updates
- Pass on the patient fee to you after consultation @ Rs150/- per consultation
- A summary of findings and treatment is requested from your end for our records
Registration Form for Medical Practitioners
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Email :
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Full Name : Dr
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Year of Graduation :
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M.B.B.S. From :
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Medical Council of :
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Registration No.:
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Postgraduate
Specialisation:
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Telephone(+STD) :
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Services Offered :
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Clinic address :
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State :
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City/District :
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Prefered Mode of Fee Payment : (Cheque/Bank Transfer) Provide Bank Name,
Account Number and Location
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I agree to the terms and conditions
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